Biomedical subjects
Publications and source records attributed to R H West.
A 39-year-old Vietnamese refugee with upper eyelid swelling followed by vertical diplopia and mild proptosis was shown by computerised tomography to have a localised lesion in the region of the right superior oblique muscle. At operation, this was a cyst and histology confirmed the larval form of Taenia solium (cysticercosis).
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Peritoneal dialysis, hemodialysis, plasma exchange and forced diuresis have been reported to accelerate removal of quinine following quinine poisoning. All these modalities were used simultaneously to treat a 19 year old youth who had become blind as a result of an overdose of quinine tablets. The serum quinine level was measured at 10.5 microgram/ml 13 hours after quinine ingestion. Forced diuresis accounted for the removal of 557 mg of quinine in the first 5 hours and a total of 1625 mg over 75 hours., A 6 hour hemodialysis recovered 30 mg of quinine while peritoneal dialysis removed an average of 1.6 mg/hr over the first 48 hours. Plasmapheresis over 3 hours exchanged 2 liters of plasma containing a total of 8.5 mg of quinine. Some vision returned 19 hours after quinine ingestion but did not become normal until 5 1/2 months later. We conclude that, hemodialysis, peritoneal dialysis and plasma exchange made only a minor contribution to quinine elimination by comparison with renal excretion of quinine.
The results of treatment with Timoptol in 138 cases are reviewed. There was an average lowering of pressure by 6mm Hg in the whole group with an average follow up of 10 weeks (range 2-26 weeks). Most patients had a satisfactory fall only when Timoptol was combined with other treatment, with a fall of 3mm Hg or more in 60% of patients and with pressure controlled to less than 22mm Hg in 48 to 55%. A good response was achieved in all types of chronic open angle glaucoma except in low tension glaucoma. In established glaucoma it seems best to add Timoptol to the existing therapy and then modify treatment as indicated. Serious side effects occurred in five patients; 2 with severe pain, 2 with an attack of angle closure glaucoma, one a general sensitivity reaction and one with temporary central visual loss, but these do not detract from the immense potential of the drug in treatment of glaucoma.
Thirty-eight patients with scleroderma (progressive systemic sclerosis) without renal failure were subjected to detailed clinical ophthalmic assessment. Abnormalities were frequent. However, many of these, including lens opacities, vitreous frosting, and arteriosclerotic changes, were considered to be age-related, and there were various incidental changes. Posterior subcapsular lens opacities in one patient were probably corticosteroid-induced. Changes related to scleroderma included eyelid abnormalities (stiffness or tightness in 11, telangiectasia in 8), deficient tear secretion (14 cases), and conjunctival abnormalities (injection 19 cases, vascular sludging 27 cases). Iris light reflux (6 cases) was possibly related to scleroderma. The changes related to scleroderma occurred in the 3 types classified according to the extent of skin involvement.
A series of fifty consecutive patients admitted to the Alfred Hospital with a primary diagnosis of traumatic hyphaema is analysed with respect to causation, size of bleed at admission, treatment, complications and ultimate visual result. The need to examine carefully the eyes of all patients presenting with a history of motor vehible accident is stressed.
A 34-year-old woman with longstanding untreated thyroprivic hypothyroidism and pituitary enlargement is reported here in whom visual failure coincided with thyroid hormone replacement. Visual fields were normal after 30 years untreated hypothyroidism, but severe concentric field constriction developed during the first 6 months of therapy and was relieved by hypophysectomy. Plasma TSH and prolactin remained elevated during 10 months replacement therapy, but both were suppressed by preoperative hyperreplacement with T3 and T4. The paradoxical pressure symptoms suggest imbalance between pituitary TSH content and TSH release during treatment with thyroid hormone; a finding previously reported in animal studies. This sequence suggests that patients with known pituitary enlargement secondary to thyroid hypofunction should be observed for pressure symptoms during thyroid hormone treatment.
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