[Use of botulinum toxin in medicine].
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Biomedical subjects
Publications and source records attributed to P Nemet.
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We have used botulinum toxin (Oculinum) for the past 2 years to treat strabismus and other ophthalmic conditions. It was effective for blepharospasm and hemifacial spasm, and in producing pharmacological ptosis. There were a few local complications, such as ptosis and diplopia, which disappeared within a few weeks. This is a new treatment modality with specific indications in ophthalmology.
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The symptomatology of congenital fibrosis of extraocular muscles, markedly restricted eye movements, blepharoptosis and chin elevation were found in 10 individuals and three generations of one family. The mode of inheritance is compatible with a variable expressive dominant trait. Our experience with the surgical management of the condition using more aggressive procedures than currently employed is described.
Three families affected by juvenile nephronophthisis are described and genetically analyzed. The extrarenal manifestations of the disease include retinal findings such as congenital Leber amaurosis, retinitis pigmentosa and sector retinitis pigmentosa. Autosomal recessive transmission and the wide phenotypic spectrum are discussed. The variability in the retinal findings is explained by the presence of a pleiotropic gene with variable expressivity.
The occurrence of congenital oculomotor apraxia in two children of the same family is described. The improvement of the ocular dysfunction in the older sister gave some hints to the benign nature of the condition and its tendency to recover with age. The possible pathophysiological mechanism underlying this anomaly is discussed.
A boy of 2 had evidence of congenital retinal non-attachment. The mother had a veil like fold in one eye. There was no evidence of any systemic disorder. The inheritance might be X-linked recessive. Mild manifestations of the disease in the carrier mother may be more frequent than has been assumed and should be looked for.
Since Hering's law might be affected when paradoxical innervation exists, 10 patients with Duane's syndrome were studied. Eye movements were measured by binocular recording of electro-oculogram. Our study shows clearly that the sound eye's motility is also affected. When adduction of the affected eye is present, Hering's law holds, whereas when adduction is limited this law cannot be demonstrated.
It is generally believed that pursuit eye movements are unaffected by cerebellar cortical atrophy or cerebellectomy. The present study was performed on patients who underwent partial vermis and hemisphere ablations as a result of severe cranial injury or cerebellar tumors. Eye movements were measured by DC electro-oculography. A clear disparity of the slow phase of the optokinetic nystagmus was observed. When eye movements were contralateral to the ablated side the slow phase of optokinetic nystagmus was statistically slower than drum or visual field velocity. It is suggested that the cerebellum network is involved in the mechanisms of the smooth pursuit movement.
It was assumed that the cerebellum is not essential for eye movements, playing only a modifying and influencing role. Recently it has been shown that the directions of the saccades can be related to a stimulated cerebellar site. This study was done on patients who underwent partial vermis and hemisphere ablations as a result of severe cranial or cerebellar tumors. The results further indicate that lack that lack of some cerebellar neural structure affects the nature of the saccade: it does not move the eyes in one saccade to acquire the new target and its amplitude duration relationship changes. It is suggested that cerebellar cortex generates a neural pulse based on teleceptive information about stimulus location with respect to an observer's head, corrects this information for initial eye position and sends out a signal to the saccadic pulse generators which move the eyes to acquire the new target.
The unusual association of macular atrophy--Jadassohn type of anetoderma, bilateral subcapsular ocular cataracts and keratoconus--is described in an otherwise healthy adult male. This association has not, to the best of our knowledge, been previously described. The possibility that this is not a chance association is discussed.
In an attempt to learn the contribution of the sympathetic system to smaller pupillary size in infants, pupillary responses were tested to agents acting on this system in 12 ihfants and 23 young adults. Phenylephrine dilated the pupils of both groups by the same ratio, with infants' pupils reaching a lesser diameter. The responses to cocaine and hydroxyamphetamine were lower in children. It is concluded that in the first months of life the postganglionic sympathetic nerve releases less norepinephrine. This may be due to a lower number of sympathetic neurons. The post-synaptic apparatus may not be fully developed in infants.
Acute transient lens opacity occurred in a patient with ruptured cornea following injection of Miochol into the anterior chamber. It is postulated that the lens changes were due to osmotic effect of the hypertonic Miochol solution.
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In an attempt to determine whether autonomic neural factors might be involved in senile miosis, we tested pupillary responses to agents acting on the ocular sympathetic system in old subjects and compared them to responses in young adults. Our results suggest that sympathetic tone is decreased in the elderly. The dilator pupillae muscle does not lose its sensitivity to norepinephrine with age.
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