[Diagnostic errors in head injuries with eye involvement].
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Biomedical subjects
Publications and source records attributed to H Busse.
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The authors report on choroid metastatic deposits from primary tumors of other organs with regard to a survey of the literature and personal observations. 85% of the choroid secondary growths occur after breast cancer in women with an average latency of 3 1/2 years. The ophthalmological appearances and the fluorescence-angiographical phenomena are discussed with regard to the differential diagnosis of melanoma and haemangioma of the choroid. The therapeutic procedure for secondary deposits of mamma carcinoma is considered.
The reasonability of cataract extractions is mentioned with exposition of the interests of the insuring bodies and of the patient. We discuss individually the terms "medical treatment", "obligation to tolerance" and "reasonability". The surgical method and the general physical assessment of the patient earn special consideration for a "reasonable" cataract extraction. We also discuss the special situation of the surgeon.
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The conservation of the tear ducts, as well as their partial conservation, must be considered when operating on smaller tumors, depending on the clinical picture and the histological aspect. However, the preparation should be done under magnification to facilitate delineation of the borders of the tumor and to immediately recognize when the tear ducts are opened. The histological description of the kind of tumor and the answer to the question of excision into the healthy tissue decide the further procedure. The placing of an indwelling tear duct probe in the form of a supramid thread or of a polyethylene tube has proved favorable. In case partial resection of the peripheral parts of the canal system is necessary, the remains of the posterior wall of the vertical or horizontal part of the canaliculus must be opened with Vanna's scissors. The remaining vertical or horizontal part of the canaliculus does not lose its suctionpressure pump capillarity when it is opened, but ensures tear drainage.
A storage disease with cardiomegaly, generalized muscular hypotonia, cerebral dysfunction, failure to thrive and early death is described in two siblings. The first one died at the age of 10 months, the second at the age of 17 months. The symptoms were mainly due to lysosomal storage of a substance which had a positive reaction to PAS and Best's stain and which was resistant to diastase. This substance was stored in nearly all the organs, especially in the heart, liver, spleen and less in the brain and skeletal muscles. An increased renal excretion of ethanolamine, a greatly increased hepatic concentration of ethanolamine and diminished hepatic ethanolamine kinase activity could be demonstrated. Ethanolamine is essential for the synthesis of phospholipids. Both parents showed increased renal excretion of taurine. In several aspects, this syndrome is similar to the glycogenosis type II described by Pompe.
The authors describe a technique for retrograde phlebography of the orbit. A selection of the typical findings in 51 cases of orbital phlebography is presented. The diagnostic importance of the examination in cases of similar clinical symptoms has been stressed. This method is best suited to the investigation of cases of venous malformation, especially of the intra-orbital, peri-orbital and retro-orbital area. Side-effects and complications have been described. A comparative assessment against other competetive methods of investigation, like the computer tomography has been attempted.
This position and relationship to the facial skeleton of the tear ducts in neonates were studies during 25 post mortem examinations by injection of contrast material into them and the findings were correlated with microscopic appearances. This produced the following results: in more than 50% cases there was unilateral or bilateral narrowing of the distal end of the duct due to persistence of Hasner's membrane. The ration of length of the tear duct and the ductus in neonates is 1:2 (adults 1:3). The proximal portions of the ducts between the saccus and the ductus show multiple transverse mucosal folds. There are several more or less acute curves in both planes. The examination indicates that in the treatment of neonatal dachryostenosis it is necessary to use a combination of dilatation and pressure injections.
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The authors describe the characteristic features of spinaliomas in the lid region, which were observed in a study of 44 patients with this clinical picture. From this we could conclude that the presence of a spinalioma is revealed by: atypical localisation in the eyelids (upper lid, lateral or medial lid angle), accelerating rate of growth or involvement of youngerer patients. And, certainly not in the last position of importance, there is a very definite inclination to recurrences, which necessitates a sufficiently radical surgical removal into the healthy tissue.
In the years 1964 to 1974 138 patients with malar fractures were treated by operation. After follow-up examination on an average of 3 years and 10 months after the operations the occuring complications in 61 patients were revealed. On the first stationary admission to hospital 14 patients complained of diplopia; on the follow-up examination only 5 paresiae were found. On the first examination after the accident 35 patients had hypoaesthesiae, anaesthesiae or paraesthesiae in the area of supply of the ophthalmic and maxillary nerves. It is remarkable that in the follow-up examination 29 patients complained still of these disturbances. Perforating injuries were not found in these patients. 2 patients had however traumatic macular foramina. 2 further patients had partial optic atrophy, a result of fracture in the region of the optic canal.
By means of a short and long-term study the recanalising effect of Kaleff-Hollwich's (1977) Dacryocystorhinostomy was determined and compared with Ohm's (1921) and Dupuy-Dutemps (1921) methods. With both procedures a high percentage (75-85) of permanent patency of the tear ducts is obtained. With Kaleff-Hollwich's method a practically continuous mucosa anastomosis can be formed. Stenosis by insufficiency of the canaliculi can be avoided in the opinion of the authors by exact refixing of the medial palpebral ligament. Information in the literature of patency in over 90 percent of cases is revealed after critical evaluation in the great majority of such reports as post-operative ability to rinse the tear ducts in one direction and give no indication of the end result.
The authors describe 6 cases of tractional retinal detachment without hole formation--five as a result of intraocular metal splinter injuries and the sixth after scleral perforation following windshield injury which was overlooked. Splinter extraction was performed twice through the perforation and three times though the pars plana from the ouside. The time between the injury and appearance of the retinal detachment varied between four months and nine years. In every case there was a diffuse falt detachment without obvious tent formation. Reattachment was successful in five cases by release of the traction from the outside by cerclage with folding of the point of traction in the vitreous body and diathermy with drainage of the subretinal effusion. This method described gives relief only when vitreous strands traverse the whole bulbus crosswise. The follow-up period is up to the present three months to a year.
The authors describe microsurgical appearances of tear-sac and nasal mucous membranes from 45 patients suffering from dacryostenosis without clinically manifest nose or sinus conditions. In addition the observations of Henle (1865), that described the continuation of expandible conchal mucous membrane up to the lower part of the tear duct were controlled. The observations gave the following results: 1. In all cases of dacryostenosis there was a past history of more or less severe acute or chronic inflammation of the nasal and tear-duct mucous membrane. 2. The submucose of the ductus naso-lacrimalis surrounded by bone contains arterioles with sphincters and cavernous vessel complexes which can cause swelling up to displacement of the canal lumen, according to the blood flow. The results support the hypothesis of the authors that "idiopathic" dacryostenosis is caused by ascending inflammations from the region of the nose and sinus cavities, which can be clinically quite inconspicuous.
We describe a variable pressure and variable distance impression funnel for the Goldmann-3-mirror contact glass. The advantage of this apparatus lies in the possibility of denting the bulbus up to the equator for the diagnosis of holes while the retina is still attached. This funnel has proved itself especially in light coagulation through the contact glass with the slitlamp.