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Biomedical subjects

G L Sutton

Publications and source records attributed to G L Sutton.

26 records · Page 2Linked to original sources
PubMed1990

Infectious crystalline keratopathy.

A 76-year-old patient was found to have a crystalline keratopathy with no evidence of acute inflammation in her right corneal graft. The patient had been on long-term topical steroids. Subsequent microscopy of the graft demonstrated pockets of Gram-positive cocci with a paucity of inflammatory cells. This is the tenth reported case of infectious crystalline keratopathy, first reported by Gorovoy in 1983. It does not always occur in corneal grafts, but the use of long-term topical steroids, together with an epithelial defect, allows the microorganism, usually Streptococcus viridans, to invade the corneal stroma and replicate along the lamellar planes, unhindered by the usual inflammatory response. Retrospective analysis of this patient's history suggests that she has suffered the same keratopathy in previous corneal grafts. Treatment involves cessation of steroids, antibiotic cover and often a repeat penetrating keratoplasty. If this is required, the lowest possible dose of steroid cover should be used with prolonged use of topical antibiotics. To the best of our knowledge this is the first reported case of infectious crystalline keratopathy in Australia.

Aged↗
PubMed1986

Imipenem pharmacokinetics in elective colorectal surgery.

A study of the pharmacokinetics of imipenem in 22 patients undergoing elective colorectal surgery was performed. Samples of plasma, fat, muscle and viscera were assayed at various intervals following intravenous injection of 1 g imipenem and 1 g cilastatin. The concentration of imipenem in plasma was approximately ten times that found in the tissues. The half-life was similar in plasma, muscle and fat (approximately 1 h). Visceral levels showed a slower fall (T 1/2 83 min). Plasma and tissue levels exceeded the MIC90 for all common pathogens for at least the first two hours of surgery. We conclude that imipenem is a suitable agent for antibiotic prophylaxis in colorectal surgery.

Colon↗
PubMedDate not supplied

Plasma and red blood cell vitamin E status of patients on total parenteral nutrition.

Plasma and red blood cell (RBC) tocopherol isomer (alpha, beta, delta, and gamma) concentrations were measured prior to, and following total parenteral nutrition (TPN), with Intralipid. Before feeding, nine of 13 patients had plasma total tocopherol levels less than 0.6 mg/dl (normal range 0.63-1.24 mg/dl) and 10 of 13 had total RBC tocopherol levels less than 0.2 mg/dl (normal range (0.20-0.39 mg/dl). Following 7 days TPN plasma vitamin E status increased significantly (p less than 0.001). However, this was due mostly to increases in the circulating level of beta + gamma-tocopherols. RBC vitamin E status was also significantly increased (p less than 0.001) following TPN, however, this was again due to incorporation of non-alpha-tocopherols. In a second study a alpha-tocopherol supplement, Vitlipid N, (9.1 mg alpha-tocopherol/day) was included in the feed. In these patients, large increases in plasma concentrations of non-alpha-tocopherol isomers were accompanied by an apparent improvement in alpha-tocopherol status (0.64 vs 0.44 mg/dl after 7 days). However, RBC alpha-tocopherol concentration did not change appreciably in these patients following either 7 or 14 days feeding. It is concluded that RBC vitamin E status is markedly influenced by the available plasma tocopherol pool and that provision of a small supplement of alpha-tocopherol is not sufficient to compete with the high concentration of non-alpha-isomers present in Intralipid. TPN utilizing fat emulsions containing high levels of non-alpha-tocopherol isomers (even when accompanied by alpha-tocopherol supplements) does not improve alpha-tocopherol status.

Adult↗
PubMedDate not supplied

A cuffed polyurethane catheter for long-term central venous access: a novel technique prevents early displacement.

A new method which provides immediate fixation of a cuffed central venous catheter is described. The cuffed polyurethane catheter has a detachable hub which allows the creation of a second small tunnel distal to the cuff using the wire and the vein dilator. As the catheter exits from a "pinhole," immediate fixation is assured and is independent of tissue healing.

Catheterization, Central Venous↗
PubMedDate not supplied

Central focal interface opacity after laser in situ keratomileusis.

BACKGROUND: The acute onset of a focal central interface opacity with visual loss following LASIK has not been described in the peer reviewed literature. Non-peer reviewed reports of various inflammatory lesions have been recorded. METHODS: We describe three cases in which an acute focal stromal interface opacification was identified within 1 week of laser in situ keratomileusis (LASIK). Each case was performed by a different surgeon on a different day, but using the same method, materials, and the Summit Apex Plus excimer laser. Immediately after surgery, all eyes were normal with good unaided vision. The appearance of the central stromal opacity was associated with acute visual deterioration. Preoperative and postoperative cycloplegic refractions, videokeratography, and postoperative slit-lamp biomicroscopy were performed. Each case was treated with intensive topical corticosteroids. RESULTS: Each case demonstrated a central circular opacity in the interface between corneal flap and stromal bed, with associated variable stromal thinning. Resolution of the pathological process followed 2 to 4 weeks of treatment with topical corticosteroids and subsequent improvement in slit-lamp biomicroscopy, corneal topography, and vision. Etiology was uncertain. CONCLUSION: Central interface opacification is a rare but visually important inflammatory complication of LASIK.

Acute Disease↗
PubMedDate not supplied

Toric laser in situ keratomileusis for myopic astigmatism using an ablatable mask.

BACKGROUND: To assess the results of toric laser in situ keratomileusis (LASIK) correction of myopic astigmatism. METHODS: A prospective study was performed over a 20 week period for consecutive patients treated for myopic astigmatism. Spectacle-corrected visual acuity, uncorrected visual acuity, spectacle refraction, videokeratography, and complications were recorded. Vector analysis was performed by the ASSORT program. RESULTS: Sixty-five eyes of 42 patients underwent toric LASIK with a Summit Technologies Apex Plus excimer laser. Mean preoperative spherical equivalent refraction at the spectacle plane was -6.24 +/- 2.42 D (range, -1.63 to -14.63 D) and mean pre-operative refractive cylinder magnitude was 1.99 +/- 1.35 D (range, 0.75 to 7.00 D); mean attempted refractive cylinder correction was 1.90 +/- 1.00 D. Six months after LASIK (43 eyes followed), mean spherical equivalent refraction at the spectacle plane was -0.40 +/- 0.55 D and 31 eyes (72.1%) were within +/- 0.50 D of emmetropia. At 6 months, mean refractive cylinder magnitude was 0.74 +/- 0.70 D, mean surgically induced astigmatism was 1.46 +/- 0.86 D, mean absolute angle of error was 10.33 degrees, mean astigmatic correction index was 0.93 +/- 0.36 D, and mean index of success was 0.46 +/- 0.39. Uncorrected visual acuity was 6/12 or better in 34 eyes (79.1%) and 6/6 in 15 eyes (35%); spectacle- corrected visual acuity was 6/9 or better in 41 eyes (95.35%). Six eyes (14.0%) lost 1 line of spectacle-corrected visual acuity at 6 months and one eye (2.3%) lost 2 lines. Ten eyes (23.3%) gained 1 line at 6 months. CONCLUSION: Toric LASIK with an ablatable mask using the Summit Apex Plus excimer laser is a safe and relatively accurate procedure for the correction of myopic astigmatism.

Adult↗
PubMedDate not supplied

Recutting the cornea versus lifting the flap: comparison of two enhancement techniques following laser in situ keratomileusis.

PURPOSE: To evaluate enhancement techniques following laser in situ keratomileusis (LASIK). METHODS: Recutting was performed on 263 eyes and the flap was lifted in 55 eyes that had LASIK for simple myopia or myopic astigmatism. The time interval between LASIK and retreatment was 340+/-46 days (range, 270 to 892 days) in the recutting group and 215+/-36 days (range, 53 to 617 days) in the flap lifting group. Mean spherical equivalent refraction, refractive cylinder, uncorrected and best spectacle-corrected visual acuity were examined prior to, and 1, 3, and 6 months after retreatment. RESULTS: Seventeen eyes were lost to follow-up in the lifting group and 53 eyes in the recutting group. In the recutting group, mean spherical equivalent refraction improved from -1.48+/-1.25 D to -0.49+/-0.88 D at 6 months. In the flap lifting group, mean spherical equivalent refraction improved from -1.05+/-1.49 D to -0.45+/-0.39 D at 6 months. Refractive cylinder did not change significantly in either group (P = .2). There was a significant increase in uncorrected visual acuity (UCVA) of 6/6 in each group. In the recutting group, UCVA of 6/6 increased from 3.8% to 65.2% at 6 months, and in the lifting group from 3.6% to 71.1% at 6 months. In the recutting group, seven free flaps and three macerated flaps that required removal occurred. One eye in the recutting group and two in the lifting group developed significant epithelial ingrowth. No patient lost more than one line of best spectacle-corrected visual acuity (BSCVA). CONCLUSION: Both procedures were safe, effective, and highly predictable for enhancements, but flap complications may be more likely with recutting.

Adult↗