Transient quadriparesis after electric shock.
A case of acute transient flaccid quadriparesis after a low voltage electric shock is reported. The patient recovered completely with in three days.
Electric Injuries↗
Biomedical subjects
S A Sadiq
Publications and source records attributed to S A Sadiq.
Leber's hereditary optic neuropathy mitochondrial DNA mutations at nucleotides 11778 and 3460 in multiple sclerosis.
OBJECTIVES: Leber's hereditary optic neuropathy (LHON) can be difficult to distinguish from optic neuritis seen in multiple sclerosis (MS). About half of the LHON patients harbor a mutation at nucleotide (nt) 11778 in the mitochondrial (mt) DNA. In addition, mutations at nt-3460 and nt-14484 have been associated with LHON. An association of LHON and MS has been suspected for decades, and, recently, the LHON nt-11778 and nt-3460 mtDNA mutations have been found in several patients with MS or MS-like disease. We attempted to determine which MS patients should be evaluated further for LHON mutations. METHODS: We screened 103 clinically definite MS patients (age range from 18 to 72 years, 27 men and 76 women) for the LHON nt-11778 and nt-3460 mtDNA mutations. RESULTS: Neither mutation was identified in the patients. CONCLUSIONS: Our findings confirm previous reports which found that both LHON mutations are rare in unselected MS patients. The reports to date suggest that MS patients with peripapillary teleangiectasia typical of LHON, with relatives harboring LHON or with early severe bilateral optic neuropathy, particularly if female, should be further evaluated for LHON mutations.
Adolescent↗
A clinical algorithm for the management of facial nerve palsy from an oculoplastic perspective.
BACKGROUND/AIMS: Facial nerve palsy can be a sight-threatening complication. We have developed a flow diagram to aid in the management of these patients so that corneal complications may be avoided. This involves the recognition of a facial palsy and institution of treatment as guided by the flow chart. METHOD: Fifty-six patients suffered a facial nerve palsy following acoustic neuroma surgery. All received regular topical ocular lubrication, followed by either botulinum toxin A (BTXA)-induced ptosis (if corneal exposure developed despite conservative treatment) or definitive eyelid surgery. RESULTS: Twenty-one patients required regular lubrication only. Of these patients treated for corneal exposure, 20 received BTXA with good resulting corneal cover. Unfortunately, 9 of these suffered diplopia, although in 4 this resolved quickly. Twenty-four patients underwent a total of 64 eyelid procedures including levator recession, lateral tarsorraphy, lateral canthal sling, medical canthoplasty and gold weight insertion. All patients had good corneal cover post-operatively and were cosmetically improved. Of the 56 patients with a facial nerve palsy, 7 presented with a corneal epithelial defect or an infected corneal ulcer. These all responded to treatment with BTXA, topical antibiotics and/or lubrication, and eyelid surgery. CONCLUSIONS: Post-operative facial palsy may result in a significant ophthalmic workload. Although a proportion of patients with a facial nerve palsy manage well with regular lubrication, additional help with eyelid closure, either in the way of BTXA-induced ptosis in the short term or definitive eyelid surgery in the long term, is often required. Eyelid surgery seems to be the mainstay of treatment, for both function and cosmesis, with many patients requiring a combination of procedures.
Adult↗
The effect of timolol drops on respiratory function.
PURPOSE: Recently, attention has been focused on the adverse drug reactions of topical timolol, especially with regard to respiratory function in the elderly. This study was designed to assess whether timolol causes an alteration in lung function in patients without pre-existing respiratory disease and who have not suffered the impact of long-term beta 2 blockade. METHODS: A placebo-controlled randomised, double-masked, cross-over study was carried out on 20 ocular hypertensive patients with intraocular pressures over 21 mmHg, normal optic discs and full visual fields by Humphrey perimetry. Subjects received single-dose units of timolol maleate 0.5% drops or normal saline drops. Both were instilled in one eye or systemically (sublingually). The peak expiratory flow rate (PFR), forced expiratory volume (FEV), vital capacity (VC) and FEV/VC (%) ratio were all measured both before and after each type of drop and route of administration. RESULTS: Two hours after instillation of timolol there was no change in PFR (p = 0.67) or VC (p = 0.40), but there was a fall in FEV (p = 0.038) and the FEV/VC (%) ratio (p = 0.041). The fall was greatest after topical administration. CONCLUSIONS: Our results show that in our group of patients there was a tendency towards mild bronchial obstruction after topical timolol, although this was not clinically significant.
Administration, Oral↗
Epiphora: a quick fix?
PURPOSE: To assess whether any simple, easily performed and minimally invasive procedure may help the symptoms of patients with functional nasolacrimal obstruction without recourse to elaborate investigation or major surgery. A randomised study was performed to assess the success of retropunctal cautery (RPC) and one-snip punctoplasty in this condition. METHODS: In the absence of any cause for excess lacrimation, eyelid malposition or nasolacrimal obstruction, patients underwent either syringing alone (group A, n = 15) or syringing with RPC and a one-snip punctoplasty (group B, n = 15). RESULTS: Three months after treatment, six patients in group A were improved, compared with 13 in group B (Fisher's exact test, p = 0.0096). CONCLUSIONS: We would recommend that patients who suffer from a pump or functional nasolacrimal obstruction should receive RPC and a one-snip punctoplasty following the demonstration of a patent system on syringing. These simple procedures would not impair further investigation or lacrimal surgery if required in the future.
Adult↗
Use of indomethacin for pain relief following scleral buckling surgery.
BACKGROUND/AIMS: Patients undergoing scleral buckling and cryotherapy suffer from mild to moderate postoperative pain. As good pain relief facilitates post-operative ocular examination, as well as patient comfort and recovery, the authors designed a prospective randomised double masked trial to evaluate the efficacy of indomethacin as a satisfactory analgesic for such patients. METHOD: Patients with a primary uncomplicated rhegmatogenous retinal detachment requiring scleral buckling and cryotherapy were randomly allocated to receive either indomethacin or placebo. A rectal suppository was administered 2 hours before surgery, followed by two capsules twice daily for 10 days. Pain relief was assessed with a linear graphic rating scale at the end of each day. Supplementary analgesia was allowed and recorded. RESULTS: 12 patients received indomethacin (group A) and 16 received placebo (group B). The extent of surgery was similar in both groups. One patient in group A, and two in group B withdrew after 3 days. The pain scores were converted to changes from the baseline (score on day 1), and the area under the curve calculated for each patient. The means of the areas were analysed with the Mann-Whitney test and showed that indomethacin caused a statistically significant reduction in pain score, both at 3 days (p = 0.04) and at 10 days (p = 0.014). There was no statistically significant difference in extra analgesic requirements between the two groups (p = 0.2). CONCLUSIONS: Indomethacin is recommended for short to medium term pain relief following scleral buckling and cryotherapy.
Anti-Inflammatory Agents, Non-Steroidal↗
Evaluation of contamination of used disposable contact lenses by Acanthamoeba.
PURPOSE: The purpose of this study was to evaluate the contamination of used disposable soft contact lenses with Acanthamoeba. METHODS: We evaluated 51 consecutive disposable soft contact lens wearers in a prospective study. Before their check-up visits, patients were offered a free new contact lens in exchange for donating their old one. The used contact lenses (n = 102) were then removed and placed in culture medium for Acanthamoeba. We subsequently investigated patterns of wear and hygiene habits. RESULTS: The mean age of this population was 32.6 +/- 11.0 years. The average time of disposable soft contact lens wear was 13.7 hours per day. The contact lenses were disinfected daily with commercial solutions. Twenty-five (49.0%) subjects did not clean their lens cases properly. Acanthamoeba was not isolated from any of the 102 lenses. CONCLUSIONS: There were no cases of Acanthamoeba contamination in a small population of disposable soft contact lens wearers who regularly disinfected their lenses with standard commercially available contact lens solutions.
Acanthamoeba↗
Endoscopic holmium:YAG laser dacryocystorhinostomy-safe and effective as a day-case procedure.
Endoscopic holmium laser dacryocystorhinostomy can be used safely and efficiently to relieve symptoms of distal nasolacrimal duct obstruction. It has great advantages over the conventional external approach as it can be done as a day-case procedure under local anaesthesia. The excellent ablation of bone and soft tissue using this type of laser contribute to the fact that the procedure can be performed in a mean time of 20 minutes. We report on the results of our first 50 patients and review the literature on the subject.
Aged↗
The effect of heparin-coated intraocular lenses on intraocular pressure following combined trabeculectomy and cataract surgery.
PURPOSE: To review the effects on intraocular pressure control of the use of standard and heparin-coated intraocular lenses (IOLs) following combined cataract and glaucoma surgery after a minimum period of 2 years. METHODS: Case note review of all patients with glaucoma who required cataract extraction combined with trabeculectomy and who were randomized to either of the two IOL types. The number of ocular hypotensive medications and the intraocular pressures were recorded pre-operatively and at 3, 6, 18 and 24 months following surgery. RESULTS: The two groups (9 receiving standard IOLs and 10 heparin-coated IOLs) were comparable for age, sex and follow-up, as were the pre-operative intraocular pressures and number of treatments. Post-operatively, all patients achieved an intraocular pressure < 21 mmHg at the final visit, with only one patient in each group requiring topical medication, but the standard lens group had a higher intraocular pressure at 2 years (p<0.05). The magnitude of the fall from the pre-operative values was greater in the heparin-coated lens group at 2 years after surgery (p<0.02). The presence of a visible drainage bleb occurred equally frequently in the two groups. CONCLUSIONS: Use of a heparin-coated IOL does not adversely affect the intraocular pressure control following combined cataract and drainage surgery. The greater fall in intraocular pressure at 2 years in those receiving a heparin-coated IOL may have occurred by chance.
Aged↗
Endonasal laser dacryocystorhinostomy--medium term results.
BACKGROUND/AIMS: Endonasal laser dacryocystorhinostomy (ELDCR) has many potential advantages over conventional external DCR. Although the short term results of this technique have been reported, little is yet known of the long term results, and the occurrence of late rhinostomy failure. The aim of this study was to examine the results at 3 and 12 months following ELDCR. METHOD: The notes of all consecutive ELDCRs performed between November 1993 and May 1995 were retrieved. Demographic information, details of surgery, and the postoperative results were noted. RESULTS: ELDCR procedures which did not undergo lacrimal stenting showed a short term success rate of 67% at 3 months, and a further failure rate of 9% at 12 months. ELDCRs which did undergo lacrimal stenting showed a short term success rate of 82% at 3 months, and a further failure rate of 21% at 12 months. Lacrimal intubation increased the long term success rate by 8%. The success rate was lower in the presence of local risk factors for nasal mucosal scarring. CONCLUSIONS: ELDCR requires some adjunctive treatment to improve maintenance of the nasal mucosal ostia if it is to complete successfully with external DCR on grounds other than cosmesis and patient convenience.
Adult↗
Hereditary hemochromatosis: presentation and diagnosis in the 1990s.
OBJECTIVES: In the past, patients with hereditary hemochromatosis have been identified predominantly from symptomatic presentation or from family studies. In the 1990s, iron studies on routine screening chemistry panels have become more commonplace. The purpose of this paper is to describe the clinical, laboratory, and presenting features of a series of patients with hereditary hemochromatosis, diagnosed from 1990 to 1995. METHODS: Clinical information, serum and liver iron studies, liver histology, and phlebotomy requirements were evaluated in 40 patients with newly diagnosed hereditary hemochromatosis prospectively referred to a tertiary university-based hepatology clinic. RESULTS: Eighty-three percent of patients came to medical attention as a result of screening blood work: 73% were asymptomatic and 78% had normal physical examinations. Only three patients had cirrhosis from hemochromatosis alone, only two were diabetic, and only two had increased skin pigmentation. These findings are in contrast to previous reports of hemochromatosis probands in which patients with symptoms and more advanced disease were identified. The hepatic iron concentration, hepatic iron index, and age at diagnosis were similar for men and women. CONCLUSIONS: With the use of screening iron studies on routine serum chemistry panels, patients with hemochromatosis can be identified and subsequently treated before they have symptoms or organ damage.
Adult↗
Anti-MAG and anti-SGPG antibodies in neuropathy.
We compared the binding of human antibodies from patients with neuropathy to the myelin-associated glycoprotein (MAG), to its cross-reactive glycolipid sulfoglucuronyl paragloboside (SGPG), and to sections of peripheral nerve. Titers were correlated with the clinical presentation and results of electrophysiological and pathological studies. Most patients had a predominantly sensory or sensorimotor demyelinating neuropathy and highly elevated antibodies to both MAG and SGPG, but 2 had highly elevated antibodies to MAG alone, and 1 to SGPG alone. Two patients had predominantly motor neuropathy and highly elevated antibodies to SGPG which reacted with MAG by Western blot but not by enzyme-linked immunosorbent assay. One patient had amyotrophic lateral sclerosis and antibodies to SGPG but not to MAG. These studies indicate that the neuropathic syndrome associated with anti-MAG or -SGPG antibodies are more heterogeneous than previously suspected, and that although most of the antibodies react with both MAG and SGPG, some may react with MAG or SGPG alone.
Aged↗
Dysversion of lateral eyelashes in children: a new diagnosis.
We believe that a previously undocumented cause of recurrent red, watery, sore and itchy eyes in children is dysversion of the lateral eyelashes. Diagnosis requires a close examination of the lateral aspect of the eyelids where dysverted lashes are seen to be growing from normal follicles. The lateral lashes are fine, long and flexible. They curve inwards and rub on the conjunctiva and cornea, and cause the above symptoms. Secondary signs include skin changes, recurrent conjunctivitis, and corneal abrasions. Conservative treatment consisting of manual repositioning of the dysverted eyelashes is recommended so that surgery may be avoided. Recognition of the condition by the primary practitioner, and institution of the straightforward treatment described above, can obviate much morbidity. The inappropriate use of topical antibiotics and frequent return visits to the practitioner may also be thus avoided.
Child, Preschool↗
Endoscopic holmium:YAG laser dacryocystorhinostomy.
The early results of the first 50 primary endonasal laser dacryocystorhinostomies in 49 patients performed with the holmium:YAG laser are presented. Overall, 35 (70%) were successful in relieving symptoms of nasolacrimal obstruction after a mean follow-up period of 4 months. This improved to 79% in the subgroup of patients who underwent intubation of the naso-lacrimal system. These results were similar to the results of a retrospective study of 67 patients undergoing conventional dacryocystorhinostomy in our unit. Conventional surgery was performed under general anaesthesia in all but 1 case and all were treated as inpatients, with a mean hospital stay of 2.3 days, whereas all but 1 of the laser group had their surgery under local anaesthesia and 46 operations (94%) were performed as an outpatient procedure. Surgery was significantly quicker with the endonasal laser technique and 90% of patients questioned found this technique to be entirely acceptable.
Aged↗
Aniridia in only one identical twin.
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Diseases in Twins↗
Sublingual timolol--an alternative to topical medication in glaucoma?
AIMS: To assess whether timolol drops lower a raised intraocular pressure (IOP) when given sublingually. This route of administration would be useful for glaucoma patients who are unable to instil their own drops--for example, because of stroke, poor vision, arthritis, poor coordination, or blepharospasm. METHODS: A placebo controlled randomised, double masked, crossover study was undertaken in the glaucoma clinic of a large teaching hospital. Twelve patients with ocular hypertension with IOPs over 21 mm Hg, normal optic discs, and full visual fields were examined by Humphrey perimetry. Single dose units of timolol maleate 0.5% drops and normal saline drops were given by instillation in one eye or sublingually. The IOP of both eyes, pulse rate, and blood pressure were all measured before and after each type of drop and route of administration. RESULTS: Two hours after instillation of timolol in one eye, the IOP in the treated eye was reduced by a mean of 8.5 mm Hg (p = 0.0000), and by 1.66 mm Hg in the fellow eye (p = 0.03). Two hours after sublingual instillation of timolol, the IOP was reduced by 7.55 mm Hg in the study eye (p = 0.0000) and by 7.7 mm Hg in the fellow eye (p = 0.0000). There was an equal amount of reduction in pulse rate by either route, but there was no significant change in blood pressure. CONCLUSIONS: The results show that, at least after 2 hours, sublingual treatment is almost as effective as topical treatment in lowering a raised IOP.
Administration, Sublingual↗
A case of transorbital intracranial damage underlying a seemingly innocuous injury.
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Child↗
Progression of diabetic retinopathy and rubeotic glaucoma following cataract surgery.
There has been recent interest in the progression of diabetic retinopathy following extracapsular cataract extraction (ECCE) especially with vitreous loss. It is well known that diabetic retinopathy progresses after intracapsular cataract extraction (ICCE) but was thought to be less common after ECCE. We present 7 patients with symmetrical non-proliferative diabetic retinopathy who underwent ECCE with intraocular lens (IOL) implantation. These patients ranged in age from 56 to 69 years; 2 were insulin-dependent diabetics (IDDM) and 5 non-IDDMs. Rubeosis iridis developed quickly between post-operative outpatient visits despite good diabetic control and a static retinal picture in the fellow eye. Visual loss following the onset of rubeosis was severe, with 3 patients needing cyclocryotherapy and eventually having no perception of light. The rapid onset of rubeosis between post-operative outpatient visits leads us to suggest much shorter periods between reviews than is current practice and the consideration of routine panretinal photocoagulation in the immediate post-operative period in diabetics with worsening retinopathy after ECCE and IOL. Possible causes of the increase in neovascularisation and rubeosis are discussed. The most important message highlighted by these case histories is that the surgery and follow-up of diabetic patients undergoing surgery should be undertaken by an ophthalmologist with an interest in diabetes. Where there is no recognised diabetic retinal specialist in a unit, then early referral to such an ophthalmologist is recommended when complications arise.
Aged↗