Miscellaneous localized conditions: a whirlwind review of the "Oh My Aching Back" syndrome.
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Biomedical subjects
Publications and source records attributed to F Feldman.
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We used the Schirmer filter paper test to measure tear production in 10 healthy women after instillation of local anesthetic drops at the same time of day for 30 or 31 consecutive days. We found that it was not a reliable indicator of tear production. The results varied widely even on the same subjects many of whom would, according to the standards for interpretation of the test, have been judged to produce an inadequate amount of tears.
A Choyce intraocular lens was inserted nine years after a routine intracapsular lens extraction. A year after this second operation, an acute pupil block glaucoma developed. Three weeks after the onset of the glaucoma, repeated laser iridotomies controlled the glaucoma. Pupil block glaucoma may be a complication long after intraocular lens implantation.
Eleven normal women, between the ages of 19 and 28, were examined at the same time of day, every day of a complete menstrual cycle. Measurements of intraocular pressure, anterior chamber depth, corneal thickness, and tear production were obtained. Tonographic values were obtained on eight days during the cycle. The results for ten of the women who were shown to have ovulated during the study, were then correlated with daily blood levels of luteinizing hormone, follicle-stimulating hormone, estrone, estradiol, progesterone, and testosterone, as measured by techniques of radioimmunoassay. No statistically valid correlations could be made when the various studies were analyzed and correlated.
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Bone scanning with 99mTc-diphosphonate disclosed a solitary focus of intense activity in a cervical vertebra of a 17-year-old youth with persistent unexplained neck pain. Surgery subsequently demonstrated a well-circumscribed osteoid osteoma. This experience is further evidence of the efficacy of radionuclide skeletal scintigraphy in the evaluation of benign bone disease.
The use of disodium ethane-1 hydroxy-1, 1-diphosphonate (EHDP) therapy for Paget's disease of bone was examined in 75 affected patients. Forty-eight patients received randomly assigned oral doses of either 0, 2.5, 5, 10, or 20 mg/kg/day in a controlled, double-blind protocol, and the remainder received either 10 or 20 mg/kg/day in a non-random protocol. The clinical status of the patients and appropriate laboratory tests were evaluated before treatment and at frequent intervals during a six-month period of initial therapy. There were no significant changes in either urinary hydroxyproline or serum alkaline phosphatase in those patients receiving placebos, while both these parameters decreased significantly at all dose levels of EHDP, with the greatest decline noted in the highest dose group. However, statistical analysis of the data related to changes in symptoms in the double-blind study revealed that patients receiving the higher dose of EHDP (10 or 20 mg/kg/day) had less favorable outcomes than those receiving the lower doses (2.5 or 5 mg/kg/day). The high does group had a relatively lower rate of symptom improvement and a relatively greater rate of deterioration than did the low dose group. Twenty-one of forty-nine patients followed for at least 18 months have shown a sustained suppression of their serum alkaline phosphatase and urinary hydroxyproline values for 12 months following cessation of EHDP, while therapy has been reinstituted for the other 28 patients because of increases in these measurements, with or without accompanying symptomatic deterioration. Eight patients sustained fractures through Pagetic bone during the period of study and all of these were treated with higher doses of EHDP. On the basis of the biochemical and clinical data in this study it appears that initial therapy of Paget's disease of bone with 5 mg EHDP/kg/day maximizes benefits while minimizing possible adverse effects.
A screening program staffed by ophthalmologists, ophthalmology residents, ophthalmic assistants, social workers and Chinese-speaking volunteers and directed at a Chinese immigrant community, was conducted at the Mount Sinai Hospital, Toronto. The Chinese population had been hesitant to use our hospital facilities and we hoped to overcome their fears, as well as to detect previously undiagnosed ocular problems. The program succeeded in finding many eye problems, some serious, and in encouraging this immigrant group to come for proper medical care. We describe the method of setting up and conducting such an undertaking, which involved the Departments of Ophthalmology and Social work, hospital administrators and volunteers from the community.
The Auto-Plot perimeter is a projection perimeter designed for analysis of the central 30 degrees of the visual field. It supplies clean test spots, which can easily be varied in size and colour, and the results can be recorded rapidly. However, because the screen is flat, the size and illumination of the projected spots of light vary as the targets are moved outward from the fixation point. We have devised a very inexpensive curved screen which eliminates these disadvantages.
The "shock lung syndrome," whenever associated with trauma, is probably in part the consequence of fat emboli, though aspiration, disseminated intravascular coagulation, microatelectasis, pulmonary edema, and hemorrhage due to other lung insults may be important in the etiology of many cases. When lung injury is due to fat emboli, there is an interval between the time of trauma and the onset of clinical symptoms and chest radiographic findings. The radiographic picture is that of a diffuse alveolar and interstitial lung density. In severe cases marked respiratory embarrassment requires the use of both oxygen therapy and mechanical respirators for survival.
Our initial experience with therapeutic selective arterial embolization of 3 highly vascular bone tumors is discussed. In 2 benign lesions embolization of Gelfoam particles through a large bore selective catheter facilitated complete resection by limiting hemorrhage at the time of surgery. Embolization of a vascular malignant tumor provided temporary palliation.
Roentgenographic evidence of bone and soft tissue abnormalities may be noted in the upper extremities of diabetics. Major shoulder changes, typically associated with peripheral neuropathy, include humeral head deformity due to bone resorption, joint space narrowing, subchondral cysts and sclerosis, subluxation, and juxtra-articular soft tissue bone fragments. Charcot-type joints, characterized by severe joint destruction, sclerosis, multiple bone fragments, and soft tissue swelling may occur. Diabetic neuropathy can produce flexion contractures of the hand. Abnormalities not necessarily associated with clinical neuropathy include cystic bone changes, cortical bone erosions, soft tissue calcification (calcific tendinitis), and vascular calcification.
Visual fields were assessed in 320 eyes of 169 patients, using the Friedmann Visual Field Analyzer (F.V.F.A.) and the Oculus perimeter. The F.V.F.A. was found to be a rapid indicator of both the presence, the location and the density of scotomata. Because some defects were missed by the F.V.F.A. it should be used in combination with some other technique to search for early defects, particularly in the Bjerrum region. Since the F.V.F.A. can be used easily by a technician, the physician's efforts can be utilized to best advantage in exploring those regions likely to contain abnormalities.
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