Source of immunization of infants.
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Australia↗
Biomedical subjects
M Wall
Publications and source records attributed to M Wall.
Controversies in diagnosis and management of pseudotumor cerebri.
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Humans↗
Visual loss in pseudotumor cerebri. Incidence and defects related to visual field strategy.
Visual field examinations were performed serially on 20 patients with pseudotumor cerebri using a modified Armaly-Drance visual field strategy with a Goldmann perimeter as well as an automated perimeter (Octopus). Visual loss was found in 75% of eyes using the manual strategy and in 77.5% of eyes with automated threshold perimetry. This incidence of visual loss is 50% greater than any previously reported series. All major defects detected were present with both types of perimetry. Both strategies were more sensitive for documenting visual loss than previously described strategies. Since therapy for pseudotumor cerebri is determined by the degree and progression of visual loss, a specific sensitive strategy, rather than routine screening perimetry, should be used for determination of visual loss.
Adult↗
Alexia without agraphia: clinical-computed tomographic correlations.
Four patients with alexia without agraphia had CT lesions which correlated with the clinical findings. All lesions were vascular; two were spontaneous intracerebral hematomas and two were ischemic infarctions in the posterior cerebral artery distribution. The lesions were located in the posterior portion of the dominant hemisphere. The location of the lesion correlated with the presence or absence of visual field abnormalities.
Aged↗
Threshold Amsler grid testing in maculopathies.
The Amsler grid is a suprathreshold target and thus may fail to detect relative scotomas. If the grid is viewed through two cross-polarizing filters creating low luminance conditions (threshold Amsler grid testing) the test is far more sensitive. Ten patients with disorders of the macula with normal standard white Amsler grid testing were studied with three other Amsler grid tests. Of the 15 involved eyes, 12 had visual field defects present with threshold Amsler grid testing. Tangent screen examination showed defects in 10 of these 12 eyes. The two red grids used were not as sensitive as the threshold grid. Three eyes had metamorphopsia with the white grid which became the site of a visual field defect with threshold testing. Threshold Amsler grid testing is a rapid and sensitive technique for the evaluation of the central 10 degrees of visual field in patients with maculopathies.
Adult↗
Magnetic resonance imaging in the evaluation of optic nerve gliomas.
Five patients with optic nerve gliomas were evaluated by magnetic resonance imaging (MRI). Images obtained with MRI were equal to computed tomography (CT) in evaluation of the orbital components of these tumors and superior to CT in evaluating the intracanalicular, chiasmal, and post-chiasmal extension of tumor. MRI is unimpeded by artifacts produced by surrounding bone, as encountered in CT, and also proves to be more sensitive in delineating subtle differences in fat content and hydration of neural tissues. Thus, MRI is extremely valuable in furthering our understanding of the natural and therapeutic response of optic nerve gliomas.
Adult↗
Identifying patients who might benefit from free phenytoin monitoring.
Guidelines for measuring free drug concentrations in serum have become necessary due to the easy availability of these assays as a result of the introduction of commercial kits. The present study was performed to identify patients or groups of patients in whom the serum free phenytoin fraction varied from normal, such that they might benefit from measurement of serum free phenytoin. Three hundred fourteen samples submitted for routine phenytoin analysis were studied by enzyme-modified immunoassay technique (EMIT). Thirty-eight patients on phenytoin monotherapy and without other factors thought to affect protein binding of this drug had a mean (+/- SD) free phenytoin fraction of 9.8 +/- 1.8% of total concentration (mean serum albumin concentration 43.4 +/- 3.9 g/L). The free fraction was elevated by administration of comedications which are themselves highly protein bound, and in those patients who were hypoalbuminaemic (serum albumin less than 30 g/L). The groups studied were not mutually exclusive, but stepwise regression analysis showed that other factors known to affect serum albumin (e.g., age greater than 65 years, liver or renal disease, or pregnancy) did not, in themselves, produce a significant effect on free phenytoin fraction. Similarly, an elevated total serum phenytoin concentration was not a significant factor in producing an elevation in free phenytoin fraction.(ABSTRACT TRUNCATED AT 250 WORDS)
Aged↗
Personal health records: an evaluation.
A cohort of mothers whose babies were born over one calendar month were followed up eight to 11 months after being given a personal health record for their newborn babies. Eight per cent of mothers lost the records and three more said they had not been given a record while in hospital; a total of 10% of mothers had either lost or misplaced the record. There were no particular demographic characteristics which identified the mothers who were more likely to lose the record. Most parents liked personal health records and used them frequently, as did the community health staff. Most private doctors, however, did not find them useful. Before wider distribution of such records is contemplated health workers should be adequately prepared, especially doctors in the private sector.
Attitude of Health Personnel↗
Gaze-evoked tinnitus.
Two patients developed gaze-evoked tinnitus in the year following removal of a cerebellopontine angle mass. The eighth nerve was transected in both cases. The noise was present with saccades, pursuit, and vestibuloocular eye movements. We postulate the tinnitus was due to an abnormal interaction between the vestibular nucleus and the cochlear nucleus, possibly secondary to neural sprouting.
Eye Movements↗
Slow-upward ocular bobbing.
A patient with a previously undescribed spontaneous arrhythmic vertical eye movement termed slow-upward ocular bobbing is reported. The patient had a one-and-a-half syndrome due to pontine infarction. A simplified scheme for describing the variations of ocular bobbing is proposed based on the velocity and direction of the initial eye movement.
Eye Diseases↗
Threshold Amsler grid testing. Cross-polarizing lenses enhance yield.
The Amsler grid is a commonly used test for evaluation of the 10 degrees of visual field surrounding fixation. The Amsler grid is a suprathreshold stimulus and thus may not detect relative scotomas. Therefore, we had ten patients with optic neuropathies view the grid through cross-polarizing filters that created low luminance conditions in which the grid was barely perceptible. The patients were also surveyed with a 2-m tangent screen protocol and threshold automated perimetry. The threshold Amsler grid technique increased both the number of defects found and the total area of these defects by approximately a factor of 5. Two thirds of the defects found were confirmed by one of the other screening techniques. Threshold Amsler grid testing is a rapid, inexpensive, and sensitive technique for the evaluation of the central 10 degrees of the visual field.
Humans↗
Neurosarcoidosis involving optic nerves and leptomeninges: computed tomography findings.
A case of neurosarcoidosis with extensive involvement of both optic nerves and intracranial leptomeninges is reported. Computed tomography demonstrates diffuse enlargement of the optic nerves and extensive nodular contrast medium enhancement of the leptomeninges of the anterior and middle cranial fossae extending into the frontal convexity. Only one such case has been previously reported in the computed tomography literature. Marked therapeutic response was obtained clinically and demonstrated on a follow-up computed tomography after therapy with corticosteroids. Differential diagnosis of computed tomography findings is discussed.
Adult↗
Bilateral tracheal bronchi.
A case of bilateral tracheal bronchi, first diagnosed at 14 months, is reported in a child who is currently alive and well at more than two years of age. This is only the second such case to be described in the world literature and is the only case to survive the first year of life. A tracheal accessory lung was also present. The varieties of tracheal bronchi are described. The importance of considering this uncommon abnormality in a number of clinical situations is emphasized.
Bronchi↗
Contrast sensitivity testing in pseudotumor cerebri.
Twelve patients with pseudotumor cerebri underwent sensory visual testing and the results were analyzed. Contrast sensitivity loss was detected with use of Arden gratings in nine of the twelve patients (75%) and in 13 of 24 eyes (54%). Snellen acuity was worse than 20/20 in 21% of eyes. Contrast sensitivity scores improved with resolution of the patient's papilledema whereas there was no significant improvement of Snellen acuity. Contrast sensitivity testing with Arden plates is a useful procedure for detecting visual loss and serially following patients with pseudotumor cerebri.
Adult↗
Panic attacks and psychomotor seizures following right temple lobectomy.
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Adult↗
Importance of evaluating the central visual field in occipital lobe lesions.
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Cerebral Infarction↗
A new approach for dealing with the stability of drugs in biological fluids.
The purpose of this study was to develop a procedure for investigating the stability of drugs in biological fluids based on sound experimental design and to use a statistical procedure which would allow conclusions to be made concerning stability with an acceptable degree of certainty (95%). The experimental procedure involved replicate analysis of the drug in stored and freshly prepared samples on the same day. The relative difference in response between these two sets of samples and a 90% confidence interval for the true change in response was calculated. This confidence interval enabled us to detect a pharmacokinetically relevant degradation. It is argued that this approach is superior to the stability test procedures based on the t test. The application of the method to the assessment of the stability of three different drugs in biological fluids is described.
Analgesics↗
Cost-effective application of the Centers for Disease Control Guideline for Prevention of Nosocomial Pneumonia.
Some parts of the Guideline are clearly cost-effective. Abandoning routine cultures of respiratory therapy equipment is cost-effective and should be adopted by any hospitals that have not done so already. Other practices such as the use of preoperative and postoperative instructions regarding deep breathing and incentive spirometry, and the policy of never reusing respiratory therapy equipment items that are intended for single use probably warrant further cost-benefit analysis. Finally, there is increasing evidence that changing ventilator tubing every 24 hours is not cost-effective. Changing tubing every 48 hours appears to be safe and can save hospitals substantial sums of money.
Centers for Disease Control and Prevention, U.S.↗