Unpaid accounts and how to cope with them.
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Accounting↗
Biomedical subjects
I A Abrahamson
Publications and source records attributed to I A Abrahamson.
Eye changes after forty.
The most common "physiologic" change that occurs in the eyes after age 40 is loss of elasticity of the lens, resulting in presbyopia. Xanthelasmas commonly occur at this age and should be removed only for cosmetic reasons. Entropion and ectropion can be quite irritating; both results from laxity of the eyelid tissues. Relaxation of eyelid tissues also contributes to blepharochalasis. Glaucoma and formation of cataracts are not normal changes but do appear with increasing frequency in persons over 40.
Adult↗
Cataract update.
Cataracts can be congenital or can result from traumatic injuries, local or systemic disease, or the aging process (senile cataracts). Senile cataracts are classified as nuclear, cortical or posterior subcapsular. Of the several surgical procedures and lenses used in treatment, the most exciting advance is extracapsular cataract extraction followed by insertion of a posterior chamber intraocular lens. Physicians should be aware of several common misconceptions concerning cataracts.
Age Factors↗
Frontal sinus mucocele.
Although not uncommon, and certainly not rare, frontal sinus mucocele was seen in 4 cases by the authors. Since one of the cases was rather unusual, we were prompted to evaluate the subject and prepare this manuscript. Gradual onset of unilateral proptosis should make one suspicious of a mucocele involving the paranasal sinuses, the frontal and ethmoid being the 2 most common locations. Diplopia, due to limited ocular motility on upward gaze, along with proptosis and epiphora are frequently the presenting symptoms which, in one particular case, paradoxically improved at first with topical anti-inflammatory therapy . A team approach (ophthalmologist, radiologist, otorhinolaryngologist, and neurosurgeon) are essential for an accurate diagnosis and therapeutic approach to this problem. The use of a precut template from the Caldwell projection is a very useful device to outline the contours of the frontal sinus during surgery. The not-so-frequent use of abdominal fat to fill the frontal sinus cavity is presented with no apparent postoperative fat necrosis. A 5-year follow-up has shown the patient to be free of recurrences.
Diplopia↗
Intraocular pressure tonometry.
The family physician should include measurement of the intraocular pressure in his examination. Chronic open-angle glaucoma can be discovered early. Tactile tension is not adequate. Many methods are available, but the Schiøtz tonometer is the best for general use. Careful attention to technique is required. When the tonometer reveals an intraocular pressure exceeding 21 mm. Hg, further studies are necessary for a diagnosis of glaucoma.
Glaucoma↗
Management of ocular foreign bodies.
Fluorescein staining is helpful in diagnosis. Many conjunctival foreign bodies can be removed by swab or irrigation, without anesthesia. Cycloplegics can prevent painful ciliary spasm. A surgical opening may be required for deeply embedded objects. Topical anesthesia is required for corneal foreign body removal. Caution: x-rays must be made to rule out intraocular foreign bodies in cases of flying metal. Rust rings must be removed. Mydriatics or cycloplegics can precipitate glaucoma. Corneal abrasions are easily infected. Secondary iritis may follow deeply embedded foreign bodies.
Anesthesia, Local↗
Letter: Complication of the use of Ocuserts.
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Accidents, Traffic↗
Intravenous diazepam as an adjunct to local anesthesia in ophthalmic surgery.
The addition of intravenous diazepam to other, routinely employed preoperative medications prior to intraocular surgical procedures was evaluated to determine if symptoms of extreme apprehension and anxiety could be alleviated and the necessity to resort to general anesthesia reduced. It was observed that patients who were given intravenous diazepam preoperatively sleep or were drowsy during the procedure, tolerated the surgery uneventfully and did not manifest symptoms of apprehension. Also, they could be aroused without difficulty after the procedure and were responsive to questioning and routine aftercare. The only adverse reaction, difficulty in breathing because of airway obstruction due to the tongue falling backward into the throat as a result of the light anesthesia employed, can be easily handled by lifting the chin upward or, if necessary, the use of an airway.
Aged↗
Dehydration-a cause of psychosis following cataract extraction.
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Aged↗