Biomedical subjects
Publications and source records attributed to G L White.
Disposable soft contact lenses are an alternative to conventional extended-wear lenses and provide an acceptable margin of safety and convenience for the wearer. The lenses are worn for one to two weeks and then discarded. Buildup of tear film deposits is minimized, and the need for cleaning and disinfecting solutions is eliminated. The long-term safety of disposable contact lenses is unknown.
Educating personnel regarding issues related to health and foreign travel has always been an important deployment concern. This article provides general health education guidelines pertinent to any deployment, but especially foreign deployment. The report is intended as a vehicle for initiating the health education process of nonmedical personnel prior to deployment.
Movement disorders, or dyskinesias, in the facial region may be categorized in several ways. Dystonic movement disorders in the cranial-cervical region, including essential blepharospasm, Meige syndrome and spasmodic torticollis, are characterized by uncontrollable squeezing movements in the face and neck. These disorders typically present in the fifth and sixth decades of life. Essential blepharospasm is particularly debilitating, as the involuntary eyelid closure that accompanies this condition may result in functional blindness with an otherwise normal visual pathway. Hemifacial spasm is an intermittent, unilateral, spasmodic contraction of the muscles innervated by the facial nerve. This disorder usually presents in the third or fourth decade and has a different underlying pathophysiology than the dystonias. Botulinum A toxin therapy has largely supplanted surgical intervention in the treatment of essential blepharospasm and hemifacial spasm.
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To investigate the importance of body image concerns relating to hand appearance in rheumatoid arthritis, a questionnaire was devised and administered to 80 female out-patients. Subjective judgements of hand attractiveness, feelings about hands, and behaviours relating to hand adornment and concealment were sought. Objective ratings of hand attractiveness were obtained from photographs taken at this time of the women's hands. Factor analysis indicated four principal orthogonal factors describe these body image items. Evaluative and affective elements were found to be independent of each other. The hypothesis that body image, thus rated, is relevant to desire for reparative hand surgery was tested using a two-stage general linear modelling procedure. Body image concerns, particularly negative feelings about hands, emerged as significant predictors of desire for surgery, and remained significant after the removal of variance accounted for by duration of arthritis, age, grip strength and objectively rated hand attractiveness. It is suggested that in rheumatoid arthritis, self-perception of hands and the associated emotional response, may be a covert agenda in women's decision to have surgery, and need specific clinical consideration.
Fifty-two physician assistants employed in ophthalmologic practice throughout the United States were identified. Demographic and role-delineation data from 40 PAs agreeing to participate in the study were collected by questionnaire and telephone interviews. The data indicated that the majority of ophthalmologic PAs are employed in large practices that specialize in cataract and radial keratotomy procedures and that those practices are primarily located in the Southeast and Gulf regions of the United States. The authors conclude that most PAs are being utilized appropriately by ophthalmologists, that more formalized educational and credentialing programs may be necessary for the future, and that PAs can be positive adjuncts to ophthalmologic practice.
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Summer exercises in the continental United States bring many military personnel in contact with our four types of indigenous venomous snakes. Personnel with a knowledge of these snakes, their habits, and habitat, and who exercise common sense are much less likely to fall victim to a venomous bite. When a bite does occur, timely and appropriate first aid can help to reduce the sequelae of an envenomation. Military medical personnel should be prepared to discuss snakebite prevention and field management with all personnel taking to the field this summer.
Dramatic increases in the adolescent suicide rate over the past three decades have underscored the need for risk-assessment tools. The tools that do exist are oriented to older populations and their application to adolescents is questionable. A project was initiated at the University of Utah's Health Education Department to develop a pilot instrument to examine the differences between adolescents who have attempted suicide and other teenagers. Eighty-two subjects between the ages of 14 and 19 participated in the test of this instrument. Twenty-five subjects were identified by a physician or psychologist as having failed in a sincere suicide attempt within the previous 18 months. Fifty-seven nonsuicide attempters with similar demographic profiles served as a comparison group. An 86-item questionnaire was administered to both groups. Questions were generated from a review of the literature of the past three decades for problems associated with suicide in this population. Questions were sorted into three domains (family environment, social environment, and self-perceptions), with each domain having several subdomains. Statistical analysis revealed significant differences for each of the three domains and on 55 of 86 questions. The results were used to create a streamlined instrument for assessing suicide risk that can be administered in 20 minutes.
"War games" are gaining popularity in the western United States. These recreational contests involve members of one team attempting to shoot their opponents with high-velocity dye or paint pellets fired from air guns. Unfortunately, serious eye injuries occur when participants do not use protective eye wear. We report a case of severe blunt ocular trauma resulting in a hyphema, choroidal rupture, and retinal and vitreal hemorrhage secondary to a paint pellet striking an unprotected eye. This injury resulted in a significant visual defect in this patient.
Conjunctival melanomas are uncommon. The amelanotic variety is extremely rare. We describe a patient with an amelanotic melanoma of the superior conjunctiva that was primarily excised, followed by extensive conjunctival resection and liquid nitrogen cryotherapy applied to the tumour bed. Eight months later a local metastatic lesion was noted in the lower eyelid. Eyelid metastasis in conjunctival melanoma is uncommon but may occur owing to the rich lymphatic vasculature within the conjunctiva.
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In this study the authors investigate the percentage of mismatch between job demands and worker physical capacity in Utah National Guard mechanics. This population had demonstrated a higher incidence of low back trouble than other job descriptions reviewed. The authors utilized onsite still and videotape photography and a computerized biomechanical strength prediction model to assess loads on the lumbosacral spine due to various job tasks. Job demands were then compared to the actual physical capacity of the individual workers based on static strength testing in job-related positions. A load cell on the testing apparatus entered the force generated into a computer which averaged the force of the last three seconds of a five-second lift. It was determined that as much as a 38% mismatch existed within this population for some job tasks which these workers were exposed to. Suggestions for preventing job-related low back cumulative trauma disorders are presented, including: engineering redesign, worker selection programs, work hardening, and others.
Optic nerve gliomas are slow-growing tumours most commonly seen in children under 10 years of age. Rapidly progressive proptosis and rapid visual deterioration are uncommon but may occur owing to accumulation of mucoid material, necrosis or hemorrhage. We describe a patient with an optic nerve glioma who manifested sudden proptosis and blindness caused by hemorrhage within the optic nerve sheath. The visual acuity returned to 20/25 after surgical decompression of the nerve and high-dose steroid therapy. Histopathological examination was required to establish the diagnosis of optic nerve glioma with extensive calcification. Optic nerve decompression or short-term high-dose steroid therapy, or both, may be helpful in recovering visual function in selected patients with optic nerve gliomas who have acute visual loss.
Malignant tumors of the eyelid and ocular adnexa are often detected during routine examinations. Basal cell carcinoma is the most common of these tumors, followed by squamous cell carcinoma. Sebaceous gland carcinoma and malignant melanoma are seen less frequently. Malignant eyelid tumors may mimic a number of benign conditions. Early diagnosis requires a high index of suspicion, and biopsy of the lesion is often necessary.
Primary congenital glaucoma is a rare but potentially devastating disorder that family physicians must recognize as early as possible in infants and young children. Symptoms, which may not be present at birth, classically include photophobia, excessive tearing and blepharospasm. The cornea may be enlarged and hazy. Increased intraocular pressure rapidly damages the optic nerve in infants. Treatment includes surgery with regular follow-up evaluation.