Fitness to drive: additional guidance on 1. cardiac conditions.
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Biomedical subjects
Publications and source records attributed to M Oliver.
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A patient with bilateral bullous retinal detachment caused by eclampsia of pregnancy had no signs of hypertensive retinopathy. Fluorescein angiograms during the acute stage of the disease showed normal retinal vasculature and widespread choroidopathy, probably of vascular origin, causing massive exudation to the subretinal space. Prompt recovery with good visual acuity occurred after the pregnancy ended. The only residual findings were diffuse mottling of the fundus secondary to pigmentary migration in the choroid and in the pigment epithelium of the retina disclosed by fluorescein angiography. Termination of pregnancy may be indicated in those cases where the systemic signs of toxemia are controlled medically but there is no flattening of the detached retina.
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An antibody with erythrocyte and lymphocyte activity, present in the sera of patients with systemic lupus erythematosus (SLE), demonstrated additional reactivity with neurons. The neuronal reactivity was greater with cortical neurons than with cerebellar and caudate nucleus neurons, was predominantly IgG, and was immunologically specific. Selected sera from 22 patients with active SLE were tested for the presence of antineuronal antibody. Eleven of 12 sera obtained from patients with neuropsychiatric disease demonstrated definite neuron reactivity, in contrast to only 2 of 10 sera obtained from patients without evidence of neuropsychiatric involvement (P less than 0.005). Five of 21 sera from patients with rheumatoid arthritis, but no sera from 5 other disease control groups, contained antineuronal antibody. Serial studies of 2 SLE patients with transient psychotic episodes demonstrated a close association between antibody titer and the appearance of psychosis in one. These observations suggest that the detection of antineuronal antibodies in patients with SLE may be of value in the diagnosis and management of neuropsychiatric complications.
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A single dose of 25 mg triamcinolone acetonide, when given on day 1 or 2 of the menstrual cycle, inhibits ovulation. To examine the mechanism of this action, daily determinations of plasm FSH, LH, estrone plus estradiol (E1 + E2), and progestins were performed. Some subjects also received a single dose of LH-RH or hCG on cycle day 15 or clomiphene citrate on days 5-9. Triamcinolone acetonide itself caused variable suppression of plasma estrogens, loss of the mid-cycle gonadotropin surge, and a deficient or absent rise in plasma progestins. Impaired secretion of estrogen did not seem to be due to low gonadotropin levels. FSH and LH responses to LH-RH were adequate in relation to prevailing estrogen levels. Four of six women treated with clomiphene responded with plasma progestin levels which exceed 8 ng/ml. Triamcinolone acetonide seems to affect the hypothalamic-pituitary-ovarian axis mainly by hypothalamic suppression and possibly by a direct effect on the ovary as well.
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Multiple congenital eye and hand anomalies occurred in a young female born to normal but consanguineous parents. Both eyes were microphthalmic with severe corneal, iris lens pathology. Ultrasonography revealed multiple echos from the vitreous. The ocular findings are suggestive of retinal dysplasia. A skeletal dysplasia, presenting as distal phalangeal hypoplasia, was found in both hands. There was no history of intrauterine exposure to drugs. This appears to be a unique association of congenital malformations, without other systemic involvement. Diagnostic and genetic implications are discussed.
The incidence of lymphocytotoxic antibodies in patients with systemic lupus erythematosus (S.L.E.) was significantly lower during pregnancies ending in normal live births than in pregnancies ending in spontaneous abortions (P less than 0.005). It was possible to absorb the lymphocytotoxic antibodies from S.L.E. sera with purified trophoblast antigens. The presence of a trophoblast-reactive lymphocytotoxic antibody which fails to disappear during pregnancies which end in abortion suggests an immunological mechanism for spontaneous abortion in S.L.E.
A brief description is given of the main clinical, histological and epidemiological circumstances of retinal vein occlusion. In an assessment of the pathogeneis of the condition, primacy is given to the role of arteriolar flow insufficiency and stress is laid on the long-standing capillaropathy which precedes the heamorrhagic phase of the disease. Basic therapeutic considerations are mentioned but stress is laid on the diagnosis of the pre-occlusive stage and on measures of a preventive nature that may be taken. Retinal vein occlusion and haemorrhagic cerebral infarct are compared with regard to their pathogenesis and the advantages are discussed of a common ophthalmoscopic study of retinal vein occlusion with neurologists interested in cerebral vascular disease leading to an interchange of therapeutic experience in both conditions. Finally, there are detailed the studies in retinal vein occlusion being conducted by the Jerusalem Institute for the Prevention of Blindness. These are studies of incidence, natural history and of pathogenesis as observed in the experimental disease produced in rhesus monkey.
A prospective clinical study of cold-reactive lymphocytotoxic antibodies in systemic lupus erythematosus has been completed. A highly significant association between serum lymphocytotoxicity and the development of cerebral manifestations was observed. While lymphocytotoxic antibodies from patients with cerebral lupus were absorbed by homogenates of human brain, those from patients who at no time had evidence of cerebral disease failed to cross-react with brain. It is suggested that subpopulations of lymphocytotoxic antibodies differ in their brain reactivity, and that one population may be causally related to the development of some of the features of cerebral lupus.
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It has been shown that an ultrasound system such as the Bronson-Turner Contact B Mode can be added, fruitfully, to the armamentarium of the individual pediatric ophthalmologist. It can be used quickly and precisely with an ophthalmological training and without patient discomfort or anesthesia no matter what the age. Valuable anterior segment information can be readily gained without a waterbath. Examples are shown of children with opaque media who were found to have congenital cataracts and congenital aphakia, microphthalmos, PHPV, retinal anomalies and ectatic coloboma.
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