Biomedical subjects
Publications and source records attributed to T Lifshitz.
We present a case in which a rare and serious complication with respiratory arrest and convulsions occurred after peribulbar anesthesia for cataract surgery. To our knowledge, respiratory arrest has been described as a complication only of retrobulbar, not peribulbar, anesthesia. Anesthesiologists trained in airway maintenance and ventilatory support should be available for immediate help when a peribulbar block is performed.
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The combination of microphthalmos, optic nerve coloboma, and retrobulbar cyst is very rare. We present such a case, demonstrated by ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI).
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PURPOSE: To investigate the efficacy of a new large permanent wear soft contact lens in the management of leaking blebs following trabeculectomy. METHODS: Twenty-four patients with leakage from a trabeculectomy bleb, both fornix based and limbal based, with and without mitomycin adjuvant, were treated with a 78% water content soft contact lens of 17.5 mm diameter, fit according to each patient's keratometry readings. RESULTS: The leakage from a conjunctival trabeculectomy bleb was successfully treated in 22 out of 24 patients. CONCLUSIONS: The 17.5 mm 78% water content permanent wear soft contact lens is a preferred method of management of leaking blebs when specifically tailored to the patient's corneal curvature.
PURPOSE: To report the incidence and severity of the ophthalmologic manifestations in patients with congenital insensitivity to pain with anhidrosis. METHODS: Fifteen Bedouin children with congenital insensitivity to pain with anhidrosis underwent complete ocular examination, including refraction and assessment of corneal sensation, and a detailed neurologic examination, including measurement of median nerve motor and sensory conduction. Patients with corneal ulcers were treated appropriately. RESULTS: In the 15 children (eight girls and seven boys, with a mean age of 3.75 +/- 2.67 years; range, 9 months to 9 years), corneal sensation was absent in both eyes. Corneal opacities were present in 10 children, five of whom had bilateral corneal opacities. Corneal ulcers were found in seven children, two of whom had bilateral ulcers, and in three children the ulcers recurred. The corneal ulcers were characterized by very poor healing. The surgical procedures included four lateral tarsorrhaphies, two corneal patch grafts, and one penetrating keratoplasty. All the patients had self-inflicted injuries varying from skin ulcers, burns, and bone fractures to autoamputations of fingertips and tongues. Many patients showed delayed healing and repair of bone and skin injuries. All patients had attacks of hyperpyrexia, moderate mental retardation, and hypotonicity with absent superficial sensation to light touch. Results of median nerve motor and sensory conduction studies were within normal limits. CONCLUSIONS: The patients with congenital insensitivity to pain and anhidrosis and absent corneal sensation showed a marked tendency to develop corneal ulcers that healed poorly. Congenital insensitivity to pain and anhidrosis, although rare, should be considered in the differential diagnosis of neurotrophic keratitis.
In this paper, we report on the case of a 23-year-old man who presented with a ptosis of the right upper lid and a miosis 1 month after being bitten in his right hand by Latrodectus revivenis. A positive cocaine test confirmed a diagnosis of Homer's syndrome.
To demonstrate a granulomatous reaction to silicone buckel thirteen years after retinal detachment surgery. We report on a 71-year-old man who developed a 360 degrees of epibulbar granulation tissue due to silicone circle buckel. The granulation tissue was demonstrated by a computer tomography and histologically. A granulomatous reaction to silicone circle buckel can be found many years from the first operation. Biopsy is always necessary to establish a definitive diagnosis. Treatment of 360 degrees of epibulbar granulation tissue causing ocular dysfunction is by surgical excision.
This study was designed to measure acetaminophen (paracetamol) levels in tears, and to compare it to serum levels. Paracetamol levels were measured in 20 paired tears and serum samples from 10 healthy volunteers, 1 and 2 hours after ingesting 1.5 g paracetamol. Tears were collected using glass microcapillary tubes while stimulating the conjunctiva with a small sponge placed in the lower fornix. Blood samples were taken simultaneously. The samples were analyzed for paracetamol levels using homogeneous enzyme immunoassay. Tears and serum paracetamol levels 1 hour after ingestion were 16.3 microg/mL +/- 7.2 (mean +/- SD), and 21.4 microg/mL +/- 7.7 (mean +/- SD) respectively. Tears and serum levels 2 hours after ingestion were 14.4 microg/mL +/- 7.8 (mean +/- SD), and 17 microg/mL +/- 7.6 (mean +/- SD) respectively. Tears and serum paracetamol levels of all the 20 paired samples (1 h and 2 h after ingestion) were 15.35 microg/mL +/- 7.4, and 19.25 microg/mL +/- 7.8, respectively (mean +/- SD). There was a strong and highly significant correlation between paracetamol levels in serum and in tears 1 and 2 hours after ingestion (r = 0.8, p = 0.005, r = 0.85, p = 0.002 respectively). Mean +/- SD ratio of tears/serum paracetamol levels 1 hour and 2 hours after ingestion were 0.77 +/- 0.21 and 0.81 +/- 0.25 respectively. Delta tears (difference in mean levels at 1 and 2 hours) paracetamol levels is significantly correlated with delta serum levels (r = 0.7, p = 0.025). A reliable, convenient, and feasible noninvasive method is described for measuring paracetamol in tears. There is no information in the literature about tears paracetamol secretion, and little information of tears drugs concentration.
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PURPOSE: To describe the role of ultrasound biomicroscopy in the detection and localization of foreign bodies in anterior ocular segment foreign body after trauma. METHODS: In a prospective study, ultrasound biomicroscopy was performed in five eyes of five consecutive patients with suspected anterior ocular segment foreign body. RESULTS: In all five eyes, ultrasound biomicroscopy detected and precisely localized small foreign bodies (metallic in two eyes, stone in one eye, plastic in one eye, and ceramic in one eye) in the cornea (one eye), superficial sclera (one eye), and anterior ocular segment (three eyes). Operative procedures to remove the intraocular foreign bodies (three cases) were guided by the ultrasound biomicroscopy information. CONCLUSIONS: Ultrasound biomicroscopy is a noninvasive method for detecting anterior segment intraocular foreign bodies after perforating trauma. It can be used to accurately diagnose foreign bodies and assist in surgical management, particularly when direct visualization is obscured because of the trauma. In eyes with partial-thickness corneoscleral lacerations or sealed full-thickness corneoscleral laceration and suspected anterior ocular segment foreign body, ultrasound biomicroscopy is a safe and effective method for detecting and localizing foreign bodies in the anterior ocular segment.
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AIMS: To test the effectiveness of a PC computer program for detecting vision disorders which could be used by non-trained personnel, and to determine the prevalence of visual impairment in a sample population of preschool children in the city of Beer-Sheba, Israel. METHODS: 292 preschool children, aged 4-6 years, were examined in the kindergarten setting, using the computer system and "gold standard" tests. Visual acuity and stereopsis were tested and compared using Snellen type symbol charts and random dot stereograms respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and kappa test were evaluated. A computer pseudo Worth four dot test was also performed but could not be compared with the standard Worth four dot test owing to the inability of many children to count. RESULTS: Agreement between computer and gold standard tests was 83% and 97.3% for visual acuity and stereopsis respectively. The sensitivity of the computer stereogram was only 50%, but it had a specificity of 98.9%, whereas the sensitivity and specificity of the visual acuity test were 81.5% and 83% respectively. The positive predictive value of both tests was about 63%. 27.7% of children tested had a visual acuity of 6/12 or less and stereopsis was absent in 28% using standard tests. Impairment of fusion was found in 5% of children using the computer pseudo Worth four dot test. CONCLUSIONS: The computer program was found to be stimulating, rapid, and easy to perform. The wide availability of computers in schools and at home allow it to be used as an additional screening tool by non-trained personnel, such as teachers and parents, but it is not a replacement for standard testing.
We have begun a randomized study of tele-ophthalmology. General practitioners in two participating health centres in the Negev region of Israel, serving a local population of 40,000, were invited to participate. The study group consisted of 50 consecutive patients attending the general eye outpatient clinic and 50 consecutive patients suffering from various retinal diseases attending a hospital outpatient clinic. The initial assessment was carried out via the tele-ophthalmology system. There was then a face-to-face re-examination of the same patients, in randomized order, by the same ophthalmologist on the same day, at an outpatient ophthalmology clinic.