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Biomedical subjects

L Apt

Publications and source records attributed to L Apt.

70 records · Page 4Linked to original sources
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Torsion and elevation under general anesthesia and during voluntary eyelid closure (Bell phenomenon).

The amount and interrelationship of ocular torsion and elevation was measured in 30 patients under general anesthesia; half received muscle relaxants (pancuronium bromide) during induction and half did not. Similar measurements were made in 20 patients during voluntary eyelid closure (Bell phenomenon). The mean amount of excycloduction was between 2.0 degrees and 2.5 degrees when the patients were under general anesthesia, whether or not muscle relaxants were used, and during voluntary eyelid closure. No statistically significant difference in the amount of torsion was found among the three groups. Elevation was significantly greater during voluntary eyelid closure (mean 5.3 mm) than during general anesthesia (p less than 0.01). No statistically significant difference in ocular elevation was found in patients under general anesthesia whether they were given a muscle relaxant (mean 1.5 mm) or not (mean 1.2 mm).

Adolescent↗
PubMedDate not supplied

Bacterial flora of the conjunctiva at birth.

In the largest study to date of bacterial flora in newborns, we cultured the conjunctivae of 100 infants within 15 minutes after vaginal delivery and before any antimicrobial agents had been applied to the eye. All cultures were intensively analyzed for anaerobic and aerobic bacteria. By far the largest group of bacteria isolated were microaerophilic, such as Lactobacillus species and diphtheroids, accounting for 46.8% of positive cultures and 62.3% of all bacteria isolated. The second largest group were true anaerobic bacteria, such as Bacteroides and Propionibacterium species. The smallest group were aerobic bacteria. This incidence of non-aerobic bacteria in the conjunctiva of newborns is the highest reported to date. Our finding should alert clinicians to consider non-aerobic, especially microaerophilic, bacteria in the differential diagnosis of ophthalmia neonatorum. The high rate of supposedly sterile cultures reported in other studies may be explained at least partially by improper isolation of non-aerobic bacteria.

Bacteria↗
PubMedDate not supplied

The effect of torsional muscle dysfunction and surgery on eye position under general anesthesia.

Under general anesthesia, normal eyes exhibit 2.0 degrees to 2.5 degrees of extorsion. To investigate the effect of torsional muscle dysfunction and surgery on eye position under general anesthesia, we measured the torsional change before and after torsional muscle surgery in 26 eyes of 18 patients with clinical torsional muscle dysfunction. Under general anesthesia, compared with normals, eyes with preoperative intorter overaction or extorter underaction demonstrated a significant intorsional change (P < .01). However, eyes with intorter underaction or extorter overaction did not demonstrate a significant extorsional change. Postoperatively, while patients remained under general anesthesia, intorter weakening procedures produced measurable extorsion while intorter strengthening procedures and extorter weakening procedures produced measurable intorsion. Superior oblique tenotomy produced a greater net torsional change than inferior oblique weakening surgery (P < .01). Under general anesthesia, eyes with preoperative torsional muscle dysfunction exhibit torsion in the direction consistent with the dysfunction. After surgery on the torsional muscles, a measurable torsional effect can be demonstrated while the patient is still under general anesthesia.

Adolescent↗
PubMedDate not supplied

The influence of perinatal infective factors on ophthalmia neonatorum.

BACKGROUND: Ophthalmia neonatorum still blinds approximately 10,000 babies annually worldwide. Identification of contributory maternal perinatal factors could possibly predict which babies are at greater risk for this disease. METHODS: In a randomized prospective study of ophthalmia neonatorum in Kenya, we studied the effect of prophylaxis with povidone-iodine, silver nitrate, and erythromycin in 3117 neonates. Four perinatal factors that may promote ophthalmia neonatorum were investigated: maternal vaginitis, birth in a nonsterile environment, presence of meconium at birth, and postnatal development of endometritis. RESULTS: No significant difference in the general ophthalmia neonatorum rate was found for any of the four factors (P > .14 by Fisher exact test). However, with regard to venereal ophthalmia neonatorum, the 26 infants born to mothers with vaginitis had a relative risk 5.1 times that of the rest of the infants (P = 0.0013). Their relative risk to develop gonococcal ophthalmia neonatorum in particular was 24.9 times the rest of the neonates (P = 0.0000031). Prophylaxis was with povidone-iodine in 12 infants, silver nitrate in two, and erythromycin in 12. The frequency of ophthalmia neonatorum was 25%, 100%, and 33%, respectively (differences not significant). CONCLUSION: Neonates born to mothers with vaginitis should be carefully observed for the first postnatal month for the development of ophthalmia neonatorum, even though a prophylactic agent has been used.

Anti-Bacterial Agents↗
PubMedDate not supplied

"Tissue-drag" with polyglycolic acid (Dexon) and polyglactin 910 (Vicryl) sutures in strabismus surgery.

The new absorbable synthetic sutures, polyglycolic and (Dexon) and Polyglactin 910 (Vicryl), are excellent sutures for strabismus surgery, but they have a bothersome tendency to attract adjacent tissue (tissue-drag). This difficulty is found especially with the 5-0 size suture, less so with the 6-0 size suture, and minimally with the 7-0 size suture. The presence and number of short, stubbly, protuberant strands (hooklets) seen on the surface of these sutures under high magnification correlates with the lack of ease with which the sutures pass through tissue. Other factors involved in tissue-drag include the crevices between braids in these sutures and the fiber-tissue friction due to the innate nature of the suture materials. Sutures which pass with ease through tissue, such as catgut and nonabsorbable sutures, are seen to have smooth surfaces under high magnification. Coating the 5-0 and 6-0 Dexon and Vicryl sutures to smooth their surfaces and reduce tissue-drag was ineffective with isotonic saline solution, minimally to moderately effective with glycerine and with methylcellulose and polyvinyl alcohol solutions, but highly effective with peanut and sesame oils. Though tissue-passage of Dexon and Vicryl sutures was much improved by coating with oil and entirely satisfactory, it still was not quite as good as with catgut. Clinically, the oil did not compromise the knot security or ease of handling of the sutures. No unusual postoperative reaction was seen with the use of the oiled sutures. Although oiling the synthetic absorbable sutures at time of surgery is effective, we recommend that suture manufacturers reduce the tissue-drag of synthetic absorbable sutures either by smoothing the surface in the manufacturing process or by developing an absorbable coating applied to the sutures during manufacture.

Lubrication↗