Biomedical subjects
Publications and source records attributed to R J Buckley.
We report a unique case of renal echinococcal disease. The patient presented with only a left renal pelvic filling defect without hepatic, pulmonary or other renal involvement. Management consisted of successful exploration and removal of the hydatid mass without sacrifice of renal tissue. The pathogenesis, diagnosis and treatment of echinococcal disease are reviewed.
A series of recurrent corneal erosions secondary to map-dot-fingerprint dystrophy is presented. Erosions were closely related to the Hudson-Stahli line, and this may be a factor in pathogenesis. Traumatic abrasions did not demonstrate such localisation, evidence that trauma is not a primary cause. A trial of management with therapeutic contact lenses versus topical medication was performed. Therapeutic contact lenses were shown to be inferior and had a high complication rate. Recurrent erosion is often considered an indication for therapeutic contact lenses, but this is questioned and great caution recommended in such use.
The corneal endothelia of 21 eyes afflicted with the irido-corneal endothelial (ICE) syndrome have been studied repeatedly with the clinical specular microscope. In all cases a characteristic cell type (the 'ICE-cell') is present but distributed in 4 different patterns. Accordingly, each case could be classified at any one time as one of 4 endothelial variants. One variant, always associated with elevated intraocular pressure (IOP), is characterised by a scattering of ICE-cells throughout the endothelial mosaic. This progresses rapidly to a second variant in which the entire endothelium appears 'replaced' by ICE-cells. In a third variant, associated with normal IOP, ICE-cells 'replace' only a portion of the endothelium which itself shows a great increase in cell numbers/unit area. This, apparently, slowly progresses to a fourth variant which shows a dramatic loss of endothelial cells.
Progressive iris atrophy, Chandler's syndrome and the iris naevus syndrome are recognised as subgroups of the irido-corneal endothelial syndrome but in some cases a confusing overlap of the clinical signs is found. The clinical features of five cases selected from 19 patients with this syndrome are described. The findings suggest that the disease can be better subdivided into two groups based on the morphology of the posterior corneal surface as seen with the slit lamp.
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High-power specular microscopy is now an established clinical technique. Many clinicians favour one method - contact or non-contact - or apparatus over another according to their personal requirements, and, for the time being, development of the apparatus seems to have slowed after a flurry in the last decade. Most recent developments primarily concern accessories to the existing instruments to increase their versatility. These include digital read-out pachometers, video-viewers and recorders, polaroid cameras and image analysers. Nevertheless, as the capabilities of the various microscopes are realised, there can be little doubt that other demands will be made upon them by their users and further development will be stimulated. Meanwhile, there is continuing laboratory work which attempts to keep ahead of clinical demand and which will, it is hoped, provide new parameters to the examination and study of the in vivo cornea.
The growing clinical use of specular microscopy for the examination of the corneal endothelium demands accurate interpretation of the various abnormalities or "events" encountered in the specular image of diseased endothelia. In a new method of use of a large-field specular microscope, extensive areas of the posterior surface of the cornea may be viewed in apparent relief. In this "relief mode," any entities causing events in the specular image that interrupt the smooth posterior contours of the cornea can be seen by diffuse (as opposed to specularly reflected) light, and their true size, shape, and interrelationships are clearly shown. The relief and specular images occur in the same field of view and thus allow immediate elucidation of the nature of most events.
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The selection and later relocation of specific areas of the in-vivo human corneal endothelium at relatively high magnification with a clinical specular microscope are demonstrated by case examples. Relocation of an area of the endothelium is greatly facilitated by the large field of view, the reduction of eye movement, and the presence of posterior corneal rings, induced by applanation of the cornea, which serve as a target system.
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The history of the recognition and characterization of the corneal manifestations of vernal disease is recounted. A revised classification of the 'remote' corneal signs is proposed. Forty cases of vernal plaque seen recently in London are analysed. Various parameters are discussed, and the usefulness of superficial keratectomy in the management of plaque is established. New histological findings in plaque are mentioned; these will be fully described in another paper.
The value of clinical specular microscopy of the corneal endothelium has been limited by the extremely small field of view of the image obtained. This is largely a result of an overlying brilliant reflection from the objective (or air)/cornea interface. A modification to the applanating objective cone of the contract specular microscope is described, which virtually eliminates this reflection and gives a visible field of almost 1 mm2 of the endothelium. The theory behind the objective modification is presented, and other advantages of the system, such as reduction of eye movement, are noted.
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We report a case of serious mental confusion, hallucinations, and agitation in a 65 year old man, occurring in close relationship to the intravenous administration of metronidazole. The patient was treated twice, but at different dosages. The confusion and hallucinations occurred at the recommended daily dose of 2.0 g, but did not return at a daily dose of 500 mg. Metronidazole serum concentrations were obtained throughout both courses of therapy; CSF and tissue concentrations were obtained at autopsy. The mental confusion was associated with peak serum concentrations of approximately 40 micrograms/ml. Symptoms resolved within 24-48 hr after stopping metronidazole, and resolution was consistent with a metronidazole half life of 14 hr. We conclude that metronidazole can be associated with a dose- and serum concentration-related mental confusion state, and that this side effect appears completely reversible upon discontinuing the drug.