Biomedical subjects
Publications and source records attributed to J S Till.
We have described a 14-month-old white boy with a laceration of the right upper eyelid draining CSF. Careful evaluation, including computerized tomography, revealed a penetrating injury of the right frontal fossa. Determination of the glucose level in fluid draining from upper eyelid lacerations aids in the diagnosis of CSF fistulas.
The clinical details and ophthalmologic findings of two siblings with neuraminidase deficiency (sialidosis) are presented. One patient is best classified as having sialidosis type I, while the younger sibling has features of type II. Both exhibited classic cherry-red macular abnormalities, and the patient who would permit complete ophthalmologic examination had both corneal and lenticular opacities. Markedly reduced neuraminidase activity was demonstrated in both patients. These two patients, and 48 others from the literature, were reviewed to determine the frequency of various ophthalmologic abnormalities with sialidosis. Macular cherry-red spots were present in all adequately described type I patients and all but three patients with type II disease. Visual field defects, diminished acuity, and optic atrophy, though less well documented, occurred in the majority of both type I and type II patients. Lenticular lesions were present in all but two of the 18 patients with detailed ocular examination, whereas corneal opacities were found more often in type II than type I disease.
A study of 379 patients, employed before cerebral infarction and living one year afterward, was undertaken to determine what factors had influenced their returning to work. We found age, occupation, degree of disability, race, and hemisphere infarcted to be significant. Younger patients with less disability were more likely to return to work. Patients employed in professional-managerial positions were more likely to return to work than patients in blue-collar or farming positions. Although there were no racial differences following a left-hemisphere infarct, white patients were more likely to return to work following a right-hemisphere infarct. Sex, blood pressure, severity of stroke, educational level, consciousness level at admission, maximum weakness in extremities, first v repeated stroke, care by a specially trained stroke team, rehabilitation therapy, and speech did not additionally influence the probability of returning to work.
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Cantharidin, or Spanish fly, is a lipid soluble irritant extracted from the blister beetle. Manifestations of cantharidin poisoning range from local vesiculobullous formation to gross hematuria, myocardial damage, denudation of the gastrointestinal tract, and occasionally death. Despite the wide spectrum of clinical symptomatology, the available information on this subject is extremely scanty. We have attempted the first review of this subject in this century. Currently cantharidin is the active ingredient in various wart removal compounds. The blister beetle has a ubiquitous distribution, with many species found in the southeastern United States. Although most case reports concern adults, the potential for pediatric poisoning is great. Treatment is primarily supportive.
The 30-day mortality as well as morbidity for stroke and myocardial infarction were determined by review of the charts for every carotid endarterectomy (N = 389 operations on 356 patients) performed at Wake Forest University Medical Center from 1979 through 1983 to ascertain whether the 16% morbidity and 6% mortality documented in our previous report of 1978 had changed over time. For endarterectomies performed on asymptomatic patients (n = 155), major morbidity included 2 myocardial infarctions and 1 stroke (1.9%). There were 3 fatalities--2 myocardial infarctions and 1 stroke (1.9%). For the symptomatic group (n = 234), major morbidity was 2.1%, mortality 2.6%. The combined morbidity for asymptomatic and symptomatic carotid stenosis was 2%, mortality 2.3%. Perioperative stroke rate (morbidity plus mortality) was 2.6%, 9 ipsilateral to the carotid endarterectomy, suggesting distal embolism as its probable cause. We contend that quality control measures implemented to correct the unacceptable rates reported in 1978 have contributed to dramatic and sustained reductions in complication rates.