Search PubMed⌕ Search

Biomedical subjects

L P Noël

Publications and source records attributed to L P Noël.

16 recordsLinked to original sources
PubMed1998

Topical versus intravenous administration of tranexamic acid: a comparison of intraocular and serum concentrations in the rabbit.

BACKGROUND: Tranexamic acid has been shown to greatly reduce the incidence of secondary hemorrhage when administered orally or intravenously. Topical administration of the drug should result in much lower serum concentrations, with fewer adverse effects. We performed a study to determine whether topical application of tranexamic acid would yield higher intraocular concentrations and lower serum concentrations of drug than intravenous administration. METHODS: Ten New Zealand white rabbits received 25 mg/kg of tranexamic acid intravenously every 8 hours for 3 days. Another group of 10 rabbits received one drop (0.05 mL) of commercially available tranexamic acid solution (100 mg/mL) every 8 hours for 3 days to one eye. Tranexamic acid levels in the aqueous humour, vitreous humour and serum 1 hour after administration of the last dose of drug were determined. RESULTS: Analysis of variance showed that aqueous concentrations of tranexamic acid were significantly higher with topical delivery than with intravenous administration (15 vs. 9 micrograms/mL)(p < 0.05). Serum concentrations were significantly lower following topical administration (9 vs. 19 micrograms/mL)(p < 0.01). The drug was not detected in the vitreous humour in either group. INTERPRETATION: Topical delivery of tranexamic acid may prove to be valuable in yielding therapeutic intraocular concentrations of drug in patients with hyphema while minimizing systemic toxicity.

Administration, Topical↗
PubMed1994

Antiemetic prophylaxis for strabismus surgery.

Droperidol can reduce the high incidence of vomiting after pediatric strabismus surgery; however, its use may be associated with sedation, delayed hospital discharge, dysphoria and extrapyramidal signs. Midazolam, a short-acting benzodiazepine with antiemetic properties, has few side effects and may be a suitable alternative. We prospectively compared the antiemetic effect of these two drugs in 393 healthy children aged 18 months to 14 years undergoing outpatient strabismus surgery. The children were randomly assigned to receive midazolam hydrochloride (50 micrograms/kg) (199 patients) or droperidol (50 micrograms/kg) (194 children). The incidence rates of vomiting in the two groups were 45% and 37% respectively, a nonsignificant difference. The incidence of vomiting was not affected by the duration of anesthesia, but the number of muscles repaired was a significant predictor of postoperative vomiting (p < 0.001).

Adolescent↗
PubMed1993

Brown's syndrome with contralateral inferior oblique overaction: a possible mechanism.

The simultaneous occurrence of Brown's syndrome in one eye and inferior oblique overaction in the other eye is an infrequently reported association. Review of our series of 38 cases of Brown's syndrome disclosed six patients with overaction of the contralateral inferior oblique, of whom four stepped out to contralateral superior oblique palsy. We propose that these patients initially have bilateral Brown's syndrome in infancy, and spontaneous resolution occurs in one eye only. While Brown's syndrome is present the antagonist inferior oblique muscle undergoes isometric contracture. With spontaneous resolution of Brown's syndrome a relative imbalance of forces occurs, with the superior oblique muscle now being relatively paretic compared with the contracted and fibrotic inferior oblique. Up-shoot in adduction then becomes apparent.

Child↗
PubMed1993

Outpatient treatment of microscopic and rim hyphemas in children with tranexamic acid.

Twenty-one patients aged 4 to 15 years with microscopic or rim hyphemas were treated as out-patients with systemic tranexamic acid therapy. The protocol included limited activity at home, topical steroid therapy, no dilating drops, patching for comfort or surface abrasions only, and follow-up every 24 to 48 hours. With this regimen no patient had a secondary hemorrhage. The incidence of associated injuries was surprisingly high, including four patients with angle recession, two with choroidal ruptures and four with commotio retinae, two of whom manifested retinal holes, requiring cryotherapy. We conclude that tranexamic acid therapy decreases the risk of secondary hemorrhage in ambulatory patients with hyphema, but careful assessment and follow-up are necessary to rule out associated ocular injury.

Administration, Oral↗
PubMed1993

Totally asymptomatic inferior oblique overaction.

Seventeen children were demonstrated to have completely asymptomatic overaction of one or both inferior oblique muscles. None had a constant vertical deviation in primary position, up gaze or down gaze, and significant patterns were absent. None had diplopia or complaints of torsion. The Bielschowsky head tilt test gave a negative result in all cases. No patient showed excyclorotation on fundus examination. Long-term follow-up (28 to 134 [average 75.6] months) of 13 of the patients showed that the condition did not worsen with time and may not require surgical weakening of the inferior oblique muscle.

Adolescent↗
PubMed1992

Oral administration of tranexamic acid in the management of traumatic hyphema in children.

In a prospective study 163 patients aged 17 years or less admitted to a children's hospital between April 1985 and December 1990 with traumatic hyphema were treated with tranexamic acid, 25 mg/kg given orally every 8 hours to a maximum of 1500 mg every 8 hours for 5 days. Secondary hemorrhage occurred in 5 patients (3%), none of whom had more than one rebleeding episode. In contrast, 24 (8%) of 316 patients aged 17 years or less admitted to the same hospital between January 1977 and March 1985 with traumatic hyphema who were not treated with antifibrinolytics had a secondary hemorrhage, several more than once, giving a rebleeding rate of 33/316 (10%). The results suggest that tranexamic acid reduces the incidence and number of secondary hemorrhages in children, without significant ocular or systemic side effects.

Administration, Oral↗
PubMed1991

Ocular motor apraxia following cardiac surgery.

Ocular motor apraxia is characterized by a deficiency in the generation of voluntary saccadic eye movements despite the presence of spontaneous saccades. We report two cases of isolated ocular motor apraxia, both in children, that developed following cardiac surgery. Electro-oculography was done in one case and showed slow saccades and decreased pursuit gain. The authors review the neuroanatomic and neurophysiologic features relevant to supranuclear gaze mechanisms.

Apraxias↗
PubMed1990

Limbal lensectomy in the management of ectopia lentis in children.

Surgical treatment of ectopia lentis has traditionally been associated with a poor visual outcome and a high complication rate. We treated a series of nine children (15 eyes) whose visual acuity could not be improved with optimal optical phakic or aphakic correction with limbal lensectomy. Preoperative visual acuity after amblyopia treatment ranged from 20/60 to 20/200. Improvement in postoperative visual acuity was documented in all operated-on eyes, ranging from 20/20 to 20/50 during a follow-up period ranging from 8 months to 118 months (median, 33 months). The only complication was a child who developed a secondary membrane requiring a neodymium-YAG capsulotomy.

Child↗
PubMed1990

Clinical management of orbital cellulitis in children.

A prospective study was carried out by the Department of Ophthalmology and the Division of Infectious Disease at the Children's Hospital of Eastern Ontario to assess the outcome of our medical management of orbital cellulitis in children using a predetermined antibiotic regimen and to determine whether computed tomographic (CT) evidence of a subperiosteal abscess alone was an indication for surgical drainage. Between February 1985 and January 1988, 23 patients with true orbital cellulitis were admitted. CT scans were ordered routinely at the time of admission. The scans were cancelled for 13 children because they responded rapidly to medical management. CT showed edema nasal to the medial rectus, or thickening or displacement of the muscle in 8 of the 10 children who underwent the procedure. Three children required sinus and orbital drainage, but frank purulent material was found subperiosteally in only one. The results suggest that most children with orbital cellulitis can be managed with the prompt use of the appropriate intravenous antibiotics. Therapy with cloxacillin sodium and chloramphenicol or, in children under age 6 years, cefuroxime best covers the spectrum of organisms responsible for most cases of orbital cellulitis in children. CT should be used as an ancillary guide to the need for surgical exploration of the orbit in patients who do not rapidly respond to medical management.

Abscess↗
PubMed1988

Rotatory nystagmus in infantile esotropia.

We reviewed the charts of 119 children with infantile esotropia followed for 27 months to 16 years (average 82.5 months). Of the 119, 14 (12%) had fine (high frequency, low amplitude) rotatory nystagmus. The presence of the nystagmus may account for a decline in visual acuity of up to two lines under binocular viewing conditions.

Amblyopia↗
PubMed1985

Depression in adduction syndrome.

Three cases of depression in adduction syndrome are described. All occurred unilaterally, in the left eye, in boys and were characterized by depression and retraction of the involved eye with attempted adduction. This was accompanied by an inability to elevate the eye in adduction and a markedly abnormal head posture. Surgery, consisting of superior oblique tenotomy and recession of the lateral rectus muscle, did not allow the ocular rotation to improve but did allow the anomalous head posture to be corrected. The homogeneity of the clinical appearance and the lack of response to surgery suggests that this is a distinct clinical entity.

Child↗
PubMed1983

Detection of drusen of the optic disc in children by B-scan ultrasonography.

Distinguishing between anomalous elevation of the optic disc caused by buried drusen and true papilledema can often be clinically difficult. In a prospective study of 18 children with drusen of the optic disc B-scan ultrasonography with a lowered sensitivity was found to be useful in the uncooperative child. A rational approach to the investigation of elevation of the optic disc in children is offered.

Adolescent↗