Search PubMed⌕ Search

Biomedical subjects

R J Sanders

Publications and source records attributed to R J Sanders.

At least 19 recordsLinked to original sources
PubMed1992

Retinal detachment after cataract surgery. Surgical results.

The authors studied the results obtained by the Retina Associates in 376 eyes of 361 patients operated on for retinal detachment associated with aphakia or pseudophakia with a postoperative follow-up of at least 6 months. All eyes underwent scleral buckling. The series included 103 eyes with aphakia, 17 eyes with iris-fixated intraocular lens, 111 eyes with anterior chamber (AC) IOL, and 145 eyes with posterior chamber (PC) IOL. The overall success rate for retinal detachment was 93%, without significant difference among the different groups. The aphakia and PC IOL groups had significantly higher prevalence (63% and 60%, respectively) of visual acuity equal to or better than 20/40 compared with the AC IOL group (33%). The prevalence of postoperative corneal edema in the AC IOL group was significantly higher than in the aphakia and PC IOL groups. Preoperative vitreous hemorrhage, large retinal breaks, posterior retinal breaks, total retinal detachment, proliferative vitreoretinopathy, and the need for performing a closed vitrectomy were significant factors in predicting ultimate failure.

Aged↗
PubMed1992

Retinal detachment after cataract surgery. Predisposing factors.

The authors studied the characteristics of 376 eyes of 361 patients with primary retinal detachment (RD) and surgical aphakia (103 eyes) or pseudophakia (273 eyes). Of the pseudophakic eyes, 17 had an iris-fixated intraocular lens (IOL), 111 had an anterior chamber (AC) IOL, and 145 had a posterior chamber (PC) IOL. Of the PC IOL cases, 48 (33%) had undergone YAG capsulotomy, and 46% of them developed RD within 6 months after capsulotomy. The frequency of no breaks found in pseudophakic RD (15%) was significantly higher than in RD with simple aphakia (5%). The most frequent reasons were incomplete fundus view due to a small pupil in the iris-fixated (83%) and the AC (44%) groups, and cloudiness of capsular remnants in the PC group (78%). In pseudophakic RD, sizable single tears, located more posteriorly than in RD with simple aphakia, were frequent. The authors speculate that in pseudophakic RD the retinal breaks may resemble those noted in phakic RD.

Aged↗
PubMed1992

Pseudophakic retinal detachments. Anatomic and visual results.

Retinal reattachment rates and visual results were analyzed in 227 consecutive primary pseudophakic rhegmatogenous retinal detachments. The overall anatomic reattachment rate was 90%, with no significant difference between the anterior chamber (AC) and posterior chamber intraocular lens groups. Visual results were significantly worse in the AC lens group (P less than 0.05). Negative prognostic indicators for reattachment included age greater than 65 years, poorer preoperative vision, larger extent of the retinal detachment, inability to identify a retinal break, longer duration of symptoms before presentation, and grades C or D proliferative vitreoretinopathy (P less than 0.05). In addition to the above factors, eyes with AC reaction, AC lenses, and macular detachment had a poorer visual prognosis.

Adult↗
PubMed1992

Purtscher's retinopathy preceding acute pancreatitis.

A patient with a long history of alcohol abuse had diminished vision. The clinical and angiographic findings were consistent with Purtscher's retinopathy. Subsequently, the patient was hospitalized for acute pancreatitis. To our knowledge, this is the first reported case of pancreatic retinopathy preceding the systemic findings of acute pancreatitis.

Acute Disease↗
PubMed1991

Foveal avascular zone diameter and sickle cell disease.

Patients with sickle cell disease can have a distinct retinopathy in which the posterior pole shows abnormalities, including perifoveolar vascular abnormalities. The foveal avascular zone (FAZ) was examined using fluorescein angiography in patients with sickle cell disease and in healthy normal controls. The longest FAZ diameters of 38 patients (51 eyes) with sickle cell disease were compared with those of the 48 patients (60 eyes) in the control group. The average of the longest FAZ diameter in the patients with sickle cell disease was 1.00 mm compared with 0.61 mm for the controls. This difference was statistically significant (P less than .00001). Within the sickle cell group, there were no significant differences in the FAZ diameters with respect to degree of retinopathy, type of sickle hemoglobinopathy, or visual acuity. Thus, an enlarged FAZ diameter in patients with sickle cell disease is confirmed.

Adult↗
PubMed1991

Review of arterial thoracic outlet syndrome with a report of five new instances.

Arterial damage, causing ischemia of the limb, occurs in less than 5 per cent of all instances of thoracic outlet syndrome. Arterial complications are usually associated with cervical ribs or rudimentary first ribs, but 12 per cent have occurred in patients with no osseous abnormality. The physiopathologic factors begin with compression of the subclavian artery which, in most patients, produces stenosis, poststenotic dilatation, formation of aneurysms and mural thrombosis. In other patients, aneurysms do not form, but the compression still causes stenosis, intimal injury and mural thrombosis. With either scenario, distal embolization can occur and produce signs and symptoms of ischemia that can limb-threatening. In this study, more than 200 patients reported previously and five additional sides in four patients were reviewed. Treatment depends upon the condition of the patient at presentation. Those with osseous abnormalities and no aneurysm or symptoms are not treated, while those with poststenotic dilatation or small aneurysms undergo rib resection only. Aneurysms more than twice the arterial diameter, intimal injury or mural thrombus are indications to resect, replace or bypass the subclavian artery. Patients who have had distal embolization and severe ischemic symptoms require, in addition to the aforementioned, distal thromboembolectomy, dorsal sympathectomy or both. Good results from treatment have been reported in 84 per cent of the 137 patients reported since 1970; 3 per cent required amputation and 3 per cent had cerebral emboli. Because the severe arterial complications were primarily the result of delayed therapy, they can best be avoided by early recognition, diagnosis and treatment.

Adult↗
PubMed1990

Peribulbar anesthesia for strabismus surgery.

We prospectively studied 76 patients to analyze the effectiveness of peribulbar anesthesia during strabismus surgery. The patients, ranging in age from 14 to 77 years, were given anesthesia with standard preoperative medication and a peribulbar injection of a mixture of 2% mepivacaine hydrochloride and hyaluronidase. Only one of the 76 patients required an additional injection of anesthetic to achieve adequate anesthesia. No morbidity was associated with the peribulbar anesthesia. Local anesthesia, particularly retrobulbar anesthesia, has been used as an alternative technique in an attempt to reduce the morbidity and mortality associated with general anesthesia in ocular surgery, particularly in those patients with high-risk characteristics. Even with retrobulbar anesthesia, however, there is a risk of morbidity and, in rare cases, mortality. Our results suggest that the use of peribulbar anesthesia is a safe and effective means of anesthesia in strabismus surgery because of minimal associated morbidity.

Adolescent↗
PubMed1990

Subclavian vein obstruction and thoracic outlet syndrome: a review of etiology and management.

This is a comprehensive review of acute and chronic venous obstruction, both thrombotic and nonthrombotic. It covers the anatomy, etiology, clinical features, management, and results of treatment of this uncommon condition. The typical clinical symptoms are pain and swelling in the arm, aggravated by exercise. Venography is the essential diagnostic test. The treatment options for acute thrombosis and their results include: anticoagulants, 49% improvement in 185 cases; fibrinolysis, 74% improvement in 62 cases, 36 of whom later had first rib resection and three of whom had angioplasty; and thrombectomy, 94% improvement in 33 cases. For chronic obstruction, treatment alternatives are first rib resection, 77% improvement in 97 patients; claviculectomy, 83% improvement in six patients; scalenectomy and soft tissue division, 83% improvement in 23 cases; endovenectomy, 90% improvement in 10 cases; and venous bypass, 67% improvement in 15 cases. The definitions of "improvement" are variable and sometimes ambiguous. The data do not provide a rigid guideline for specific management of each condition; rather, the options are presented with their supporting data to permit an individualized approach.

Angioplasty, Balloon↗
PubMed1990

Scalene muscle abnormalities in traumatic thoracic outlet syndrome.

Thoracic outlet syndrome (TOS) is not a single disorder but a collection of abnormalities in the same anatomic area that elicit similar symptoms. The many causes of TOS are best classified into one of three groups: osseous, traumatic, and nontraumatic. Although patients with traumatic TOS constituted 86% of our last 600 patients with TOS who underwent surgical treatment, the precise mechanism underlying the condition remains obscure. To determine if there was microscopic abnormalities, 45 anterior and middle scalene muscles from patients with traumatic TOS were studied by means of histochemical stains applied after freezing of the muscles. The results revealed a consistent abnormal histologic pattern in patients with traumatic TOS: type II fibers were atrophied; there was an increase in the average number of type I fibers (78% versus 53% in muscles from control patients); and there was a significant increase (mean: 36%) in connective tissue (muscles from control patients averaged less than 15%). Although type II fiber atrophy and type I fiber predominance are seen in a variety of other conditions, their association with fibrosis is rare. Following neck injuries, the changes in the anterior and middle scalene muscles are compatible with trauma, suggesting that fibrotic scalene muscles are an important cause of symptoms in traumatic TOS.

Adult↗
PubMed1990

Recurrent thoracic outlet syndrome.

Recurrent symptoms develop in 15% to 20% of patients undergoing either first rib resection or scalenectomy for thoracic outlet syndrome. Over the past 22 years 134 operations for recurrence were performed in 97 patients. Four operations were used: transaxillary first rib resection (26); supraclavicular first rib resection with neurolysis (15); scalenectomy with neurolysis (58); and brachial plexus neurolysis (35). Complications included temporary plexus injury (0.7%), temporary phrenic palsy (3.7%), and permanent phrenic palsy (1.4%). The combined primary success rate of all four operations for recurrence was 84% in the first 3 months. This fell to 59% at 1 to 2 years; 50% at 3 to 5 years; and 41% at 10 to 15 years. No significant difference was found in results between the four operations used for recurrence. When recurrence was caused by trauma the results of reoperations were better than when recurrence was spontaneous. The primary success rates of three initial operations for thoracic outlet syndrome were compared to their secondary success rates (improved after reoperation). By use of life-table methods, reoperation improved the 5- to 10-year success rate of transaxillary first rib resection from 69% to 86% and for scalenectomy from 69% to 84%. Reoperation is successful in most cases of recurrent thoracic outlet syndrome and better when recurrence is the result of a neck injury.

Adolescent↗
PubMed1989

Sentence comprehension following agenesis of the corpus callosum.

The sentence comprehension skills of a 6-year-old girl with callosal agenesis were compared to skills of three other children matched for age and verbal IQ. Sentence-picture matching and acting out tasks were used with reversible active, passive, and center-embedded relative clause sentences. The acallosal subject showed a deficit in syntactic comprehension. The difficulty was due to a failure to assign correct semantic roles to some sentence forms, not to a lack of ability to discriminate among the sentence forms. The data are consistent with a previous report by M. Dennis (1977, In Topics in child neurology, pp. 189-212) that in acallosal subjects syntactic comprehension can be adversely affected. Because this acallosal subject is only 6 years old, follow-up studies will be needed to determine whether she eventually acquires normal syntactic skills.

Agenesis of Corpus Callosum↗
PubMed1989

The treatment of thoracic outlet syndrome: a comparison of different operations.

Although transaxillary first rib resection is one of the popular treatments for thoracic outlet syndrome today, recurrences and nerve injuries have led to investigation of other operations that might reduce complications and improve results. This article compares the results of transaxillary first rib resection with (1) scalenectomy (anterior and middle) and (2) supraclavicular first rib resection with scalenectomy. Between 1964 and 1987, 668 primary operations were performed for thoracic outlet syndrome on 491 patients. Seventy-one percent were women. Eight-six percent gave histories of neck trauma, often a whiplash injury (traumatic thoracic outlet syndrome); 4.5% had cervical ribs. Common symptoms included paresthesia in the hands (90%); arm pain (80%); neck pain (86%); and occipital headaches (69%). On physical examination, tenderness over the scalene muscles and duplication of symptoms with the arms abducted to 90 degrees in external rotation were present in over 90% of patients. By use of life-table analysis methods, success after surgery was found to be the same for all operations: 91% to 93% at 3 months; 76% to 79% at 1 to 2 years; 70% to 73% at 3 to 5 years; and 69% to 72% at 5 to 10 years. After rib resection plexus injuries occurred in 2.6%, with partial disability in 0.5%. No plexus injuries occurred after scalenectomy, but temporary phrenic nerve palsy occurred in 4.4%. Scalenectomy is as successful an operation as first rib resection for traumatic thoracic outlet syndrome and has fewer serious complications.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1987

Ten year experience with the negatively charged glutaraldehyde-tanned vascular graft in peripheral vascular surgery. Initial multicenter trial.

The negatively charged glutaraldehyde-tanned vascular graft was developed to determine the utility of grafts of biologic origin to provide satisfactory revascularization for ischemic limbs with advanced arteriosclerotic peripheral vascular disease. The bovine carotid artery was modified under a number of conditions using a large number of variables and evaluated in the carotid artery and aorta of dogs. Eventually ficin-digested carboxylated glutaraldehyde-tanned grafts were selected as being most antithrombotic and most resistant to aneurysm formation. Under an Investigational Device Exemption with the Food and Drug Administration, 146 grafts were evaluated in 108 patients with patency approaching 67 percent for all grafts at 5 years and 59 percent at 9 years plus. Total aneurysm formation has been 4 percent (six grafts) occurring only in hypertensive patients. The graft is now undergoing clinical use and evaluation worldwide.

Adult↗
PubMed1986

Variations and anomalies of the popliteal and tibial arteries.

A review of the anatomic characteristics of the popliteal artery and its tibial branches was performed in 147 patients. The anterior tibial artery arose 6 to 8 cm below the knee joint in 91 percent of the limbs. The posterior tibioperoneal trunk was 2 to 5 cm in length in 87 percent of the patients. In 5 patients (3 percent), the posterior tibial artery originated directly from the popliteal artery proximal to the anterior tibial origin. It was located either at the knee joint or within 5 cm of it. In 75 percent, the anomalies were bilateral.

Aged↗
PubMed1985

Teaching apes to ape language: explaining the imitative and nonimitative signing of a chimpanzee (Pan troglodytes).

Fifteen videotaped conversations of a chimpanzee signing with his trainers were examined in order to determine (a) whether the ape was using imitation to learn about new language forms as some human children do and (b) whether the ape's nonimitative utterances implied knowledge of linguistic structures. The answers to both questions were negative. The evidence suggests that the utterances lacked the semantic and syntactic organization found in the utterances of most children. Instead of learning to use signs as symbols for communicating propositional messages, the ape learned to use gestures as nonsymbolic instrumental responses under the stimulus control of objects in the signing context and verbal and nonverbal cues from the trainers. Other research now underway with chimpanzees may eventually reveal whether this performance is characteristic of chimpanzees in general or is the result of particular training strategies used to teach language to chimpanzees.

Animals↗