General anaesthetic management for laser resection of central airway lesions.
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BACKGROUND: Trauma remains a major problem throughout the world. The prognosis of severe eye injuries is commonly bleak. This paper focuses on the epidemiology of eye trauma, the role of ocular epidemiology, and identification and reduction of risk factors. METHODS: An analysis of the first 8,952 patients reported with severe eye injuries, defined as those eye injuries resulting in permanent and significant (measurable and observable on routine eye examination) structural and/or functional changes to the eye, from the United States Eye Injury Registry as of 31 July 1998. RESULTS: The age of patients entered was from the 1st year of life to 103 years. Fifty-eight percent of those injured were less than 30 years of age. The male to female ratio was 4.6:1, reaching 7.4:1 in the fourth decade of life. Almost half of the injuries involved the retina, and 77% of the injured eyes required one or more surgical procedures, including a large proportion which have undergone vitreoretinal surgical procedures. CONCLUSION: Injuries remain the most serious public health problem facing developed nations. Yet, a persistent inadequacy exists both in the standardized documentation of eye injuries and in their treatment. With appropriate surgical and medical intervention, a majority of the reported injured eyes recovered functional levels of visual acuity. It appears that glasses, including prescription glasses and even non-prescription sunglasses, can offer measurable protection which results in a lower incidence of severe eye injuries to those wearing glasses.
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Postoperative wound infections develop in approximately 2-5% of all patients after orthopedic surgery. After urinary tract infection and pneumonia, such wound infections (15%) are the third most frequent type of hospital-acquired infection. In this review we summarize all proven and unproven hygiene measures available in orthopedics, giving special attention to those implemented with the aim of preventing and controlling postoperative wound infections. Routine application only of hygiene procedures of proven efficacy will be an important contribution to economic and ecological quality assurance in hospital.
Visual information regarding obstacle position and size is used for planning and controlling adaptive gait. However, the manner in which visual cues in the environment are used in the control of gait is not fully known. This research examined the effect of obstacle position cues on the lead and trail limb trajectories during obstacle avoidance with and without visual information of the lower limbs and obstacle (termed visual exproprioception). Eight subjects stepped over obstacles under four visual conditions: full vision without obstacle position cues, full vision with position cues, goggles without position cues and goggles with position cues. Goggles obstructed visual exproprioception of the lower limbs and the obstacle. Position cues (2 m tall) were placed beside the obstacle to provide visual cues regarding obstacle position. Obstacle heights were 2, 10, 20 and 30 cm. When wearing goggles and without position cues, a majority of the dependent measures (horizontal distance, toe clearance and lead stride length) increased for the 10, 20 and 30 cm obstacles. Therefore lower limb-obstacle visual exproprioception was important for the control of both limbs, even though with normal vision the trail limb was not visible during obstacle clearance. When wearing goggles, the presence of position cues, which provided on-line visual exproprioception of the self relative to the obstacle position in the anterior-posterior direction, returned lead and trail foot placements to full vision values. Lead toe clearance was not affected by the position cues, trail clearance decreased but was greater than values observed during full vision. Therefore, visual exproprioception of obstacle location, provided by visual cues in the environment, was more relevant than visual exproprioception of the lower limbs for controlling lead and trail foot placement.
Thyroid eye disease (TED) is the most frequent extrathyroidal manifestation of Graves' disease. In most instances it is mild and non-progressive, but in 3%-5% of cases it is severe. Non-severe TED requires only supportive measures, such as eye ointments, sunglasses and prisms. By contrast, severe TED requires aggressive treatment, either medical (high-dose glucocorticoids, orbital radiotherapy) or surgical (orbital decompression). The choice of treatment relies on the assessment of both TED severity and activity. Removal of controllable risk factors, especially cigarette smoking, is important to improve the course and the therapeutic outcome. A coordinated approach to the treatment of hyperthyroidism and TED is also required. Novel promising treatments, to be verified in large series of patients, include somatostatin analogues and cytokine antagonists.
The purpose of the study was to assess the effect of lens protection on image quality and radiation dose to the eye lenses in CT of the paranasal sinuses. In 127 patients referred to rule out sinusitis, an axial spiral CT with a lens protection placed on the patients eyes was obtained (1.5/2/1, 50 mAs, 120 kV). Coronal views were reconstructed at 5-mm interval. To quantify a subjective impression of image quality, three regions of interest within the eyeball were plotted along a line perpendicular to the protection at 2, 5, and 9 mm beneath skin level on the axial images. Additionally, dose reduction of a bismuth-containing latex shield was measured using a film-dosimetry technique. The average eyeball density was 17.97 HU (SD 3.7 HU). The relative increase in CT density was 180.6 (17.7), 103.3 (11.7), and 53.6 HU (9.2), respectively. There was no diagnostic information loss on axial and coronal views observed. Artifacts were practically invisible on images viewed in a bone window/level setting. The use of the shield reduced skin radiation from 7.5 to 4.5 mGy. The utilization of a radioprotection to the eye lenses in paranasal CT is a suitable and effective means of reducing skin radiation by 40%.
Visual acuity (VA) and potential risks to the radiologist's eyesight have been relatively neglected subjects in the radiological literature. This study comprises two parts, the first consisting of a questionnaire on this subject sent to a random sample of 480 practising radiologists in the United Kingdom, and the second, a spot check of the VA of radiologists in our department. Of questionnaires, 73 %were returned. Of respondents, 76 % felt that ionising radiation could affect their vision, but only 13 % used lead glasses on a regular basis. A total of 71 % felt that regular monitoring of eyesight should be required. Of 25 tested radiologists, 5 had suboptimal VA and could benefit from further correction. The pertinent literature is reviewed, and a case for periodic eyesight testing is presented, including VA and grey-scale discrimination.
BACKGROUND: The corneal temperature is not often measured, but it may be useful to evaluate the temperature-changing effect of the application of eye bandages. The reason for applying an eye bandage is to calm an inflamed eye and to provide mechanical protection. Everyone knows that some patients have more complaints after an eye bandage has been applied. This phenomenon might be caused by the inflamed eye being warmed up by bandage application. MATERIALS AND METHODS: In 40 apparently healthy subjects 24 +/- 1.93 years of age we examined the temperature changes caused by two different types of eye bandage. The measurements were done with a Jeol infrared camera. Twenty probands received a monocular bandage consisting of a perforated plastic cap and another 20 subjects a monocular mull bandage with a perforated plastic cap. RESULTS: The mean corneal apex temperature was 32.05 +/- 0.74 degrees C. Both bandages caused the corneal temperature to go up considerably. The perforated plastic cap increased the mean apex temperature by 0.58 +/- 0.48 degree K and the combined mull bandage by 1.15 +/- 0.57 degrees K (P < 0.05). CONCLUSIONS: Application of an eye bandage increases the corneal temperature significantly. This is known to change enzyme activities and to cause prostaglandin liberation and pain. A change in the bacterial spectrum may result. Cooling as a universal principle in antiphlogistic therapy might be a supplementary therapy in treating sterile, but inflamed eyes.
Visual evoked potentials measure dynamic properties of the visual system by recording transient electric responses of neural tissue identified to correspond to a specific visual stimulus, such as light or a striped grid. In this study, visual evoked potentials were used to test the visual acuity of juvenile loggerhead sea turtles (Caretta caretta) in water. Subject animals were fitted with a Plexiglas goggle filled with filtered seawater. Stimuli of black and white striped gratings were presented to the turtles using a slide projector directing an image onto a screen via a rotatable mirror that shifted the striped pattern laterally one-half cycle. Bioelectric activity was collected using a digital averaging computer and subdermal platinum electrodes, implanted under the head scutes directly above the optic nerve and the contralateral optic tectum. To isolate the response signal from the noise, signal averaging techniques were used when collecting visual evoked potentials. The resulting response waveforms included a robust positive-negative compound that was used to track the turtle's response to visual stimulation. Acuity thresholds for these sea turtles, which were derived from linear regressions analysis of the positive-negative compound amplitudes versus stripe size, ranged from 0.130 to 0.215. This acuity level is comparable to other inshore, shallow water marine species.
BACKGROUND: Intraoperative hypothermia is a common event during laparoscopic operations. An external warming blanket has been shown to be effective in preventing hypothermia. It has now been proposed that using heated and humidified insufflation gas can prevent hypothermia and decrease postoperative pain. Therefore, we examined the extent of intraoperative hypothermia in patients undergoing laparoscopic Nissen fundoplication using an upper body warming blanket. We also attempted to determine whether using heated and humidified insufflation gas in addition to an external warming blanket would help to maintain intraoperative core temperature or decrease postoperative pain. METHODS: Twenty patients were randomized to receive either standard carbon dioxide (CO2) gas (control, n = 10) or heated and humidified gas (heated and humidified, n = 10). After the induction of anesthesia, an external warming blanket was placed on all patients in both groups. Intraoperative core temperature and intraabdominal temperature were measured at 15-min intervals. Postoperative pain intensity was assessed using a visual analogue pain scale, and the amount of analgesic consumption was recorded. Volume of gas delivered, number of lens-fogging episodes, intraoperative urine output, and hemodynamic data were also recorded. RESULTS: There was no significant difference between the two groups in age, length of operation, or volume of CO2 gas delivered. Compared with baseline value, mean core temperature increased by 0.4 degrees C in the heated and humidified group and by 0.3 degrees C in the control group at 1.5 h after surgical incision. Intraabdominal temperature increased by 0.2 degrees C in the heated and humidified group but decreased by 0.5 degrees C in the control group at 1.5 h after abdominal insufflation. There was no significant difference between the two groups in visual analog pain scale (5.4 +/- 1.6 control vs 4.5 +/- 2.8 heated and humidified), morphine consumed (27 +/- 26 mg control vs 32 +/- 19 mg heated and humidified), urine output, lens-fogging episodes, or hemodynamic parameters. CONCLUSION: Heated and humidified gas, when used in addition to an external warming blanket, minimized the reduction of intraabdominal temperature but did not alter core temperature or reduce postoperative pain.
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The effects of compliance cost and warning content on the use of protective eyewear by racquetball players were evaluated. Four-hundred-twenty subjects were observed for use of eye protection in a field setting. Results indicate that proximal placement of eyewear and the inclusion of specific consequence warning information increased safety equipment use. Implications of this research for augmenting warning effectiveness and safety are discussed.
OBJECTIVE: The purpose of this study was to determine the rate of potential contamination or splashes to the face of obstetricians during vaginal and cesarean delivery. STUDY DESIGN: Clear plastic face shields were worn during 50 consecutive vaginal and 50 consecutive cesarean deliveries. The face shields were then analyzed for evidence of contamination, and rates of contamination were compared. RESULTS: The contamination rate of the face shields was 50% during cesarean deliveries and 32% during vaginal deliveries. Ninety-two percent of the contaminated face shields were undetected by physicians at the time of cesarean delivery and 50% were undetected at the time of the vaginal delivery. CONCLUSIONS: Obstetricians commonly receive blood or amniotic fluid splashes to the face during deliveries and should wear protective eyeglasses or face shields during all deliveries to minimize the risk of exposure to potentially infectious blood and body fluids.
I designed this experiment to determine if spectacle lenses would protect against a No. 6 shot fired from a 12-gauge shotgun over progressively longer testing distances, and compared plastics, heat-tempered glass, and chemical-tempered glass lenses of standard and industrial thicknesses. The likelihood of a spectacle lens being hit by a well-centered shot pattern at 40, 50, and 60 yards was approximately 66%, 25%, and 20%, respectively. Virtually all lenses were destroyed at a testing distance of 30 yards. At 40 yards, standard-thickness plastic and heat-tempered lenses were destroyed but the chemical-tempered lenses offered some protection. At 40 yards, all types of industrial-thickness lenses provided protection but the most protection was provided by the chemical-tempered lenses. At 50 yards, chemical-tempered lenses offered more protection than either plastic or heat-tempered lenses. Throughout the experiment, plastic lenses performed no better than heat-tempered lenses.
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We examined 11 overweight men, ranging in age from 34 to 56 years, who had the floppy eyelid syndrome, a disorder of unknown origin manifested by an easily everted, floppy upper eyelid and papillary conjunctivitis of the upper palpebral conjunctiva. The upper eyelid everts during sleep, resulting in irritation, papillary conjunctivitis, and conjunctival keratinization. Effective treatment consists of preventing the upper eyelid from everting while the patient is sleeping.
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