RESUMEN
PURPOSE: We report a case of posterior ischemic optic neuropathy after uncomplicated cataract extraction. DESIGN: Observational case report. METHODS: Retrospective description of the natural course of posterior ischemic optic neuropathy in one patient seen at an academic institution. RESULTS: The patient had sudden vision loss after uncomplicated cataract surgery with the features of an optic neuropathy, no acute disk swelling, and delayed optic nerve head perfusion on fluorescein angiography. CONCLUSIONS: Posterior ischemic optic neuropathy rarely occurs after uncomplicated cataract surgery, and should be considered in the setting of postoperative vision loss.
Asunto(s)
Neuropatía Óptica Isquémica/etiología , Facoemulsificación/efectos adversos , Anciano , Femenino , Angiografía con Fluoresceína , Humanos , Neuropatía Óptica Isquémica/diagnóstico , Estudios Retrospectivos , Trastornos de la Visión/diagnóstico , Trastornos de la Visión/etiología , Agudeza VisualRESUMEN
PURPOSE: To describe the postoperative capsular bag distension that occurs with in-the-bag implantation of the soft acrylic (AcrySof) intraocular lens (IOL). SETTING: Jules Stein Eye Institute, University of California, Los Angeles. METHODS: Nine eyes in nine patients had uncomplicated continuous curvilinear capsulorhexis, phacoemulsification, and in-the-bag implantation of the AcrySof lens. Comprehensive ophthalmic examinations were performed 1 day and 1 and 6 weeks postoperatively. Patients had neodymium:YAG laser posterior capsulotomy; refractions were done before and after the capsulotomy. RESULTS: Comprehensive ophthalmic examination revealed variable degrees of anterior chamber shallowing, anterior displacement of the IOL within the bag, and distension of the posterior capsule away from the IOL. Unexpected postoperative myopic correction was seen in all patients. Postcapsulotomy mean spherical equivalent refractive shift was +3.6 diopters (D) with a shift of at least +4.0 D in four of nine eyes. CONCLUSIONS: Capsular bag distension is a previously described postoperative complication that we observed in association with the AcrySof IOL.
Asunto(s)
Acrilatos/efectos adversos , Cápsula del Cristalino/patología , Lentes Intraoculares/efectos adversos , Complicaciones Posoperatorias/etiología , Estudios de Seguimiento , Humanos , Terapia por Láser , Facoemulsificación , Complicaciones Posoperatorias/patología , Refracción OcularRESUMEN
Fluconazole administered at 150 mg/week for 1-5 weeks is effective orally against dermatophytes and yeast in stratum corneum. Clinical and mycological cure rates approach 90%, but the precise distribution of the drug within various layers of skin is uncertain. We administered fluconazole at 150 mg/week for 2 weeks to 5 volunteers. Distribution of fluconazole in biopsies of skin was imaged by energy dispersive analysis of X-rays (EDX) and transmission electron microscopy, and in cells by electron energy-loss spectroscopy (EELS). Eight hours after a second dose, EDX showed fluconazole highest and homogeneously distributed in stratum corneum, lower in the rest of the epidermis, and lowest in dermis. The highest fluconazole levels detected by EELS were in cytoplasmic inclusions of sweat and sebaceous glands and less in keratinocytes and dermal collagen. We conclude that fluconazole delivered to stratum corneum by direct diffusion from capillaries and in sweat is also in all likelihood transported in sebum.
Asunto(s)
Antifúngicos/farmacocinética , Epidermis/metabolismo , Fluconazol/farmacocinética , Piel/metabolismo , Administración Oral , Adulto , Antifúngicos/administración & dosificación , Antifúngicos/análisis , Biopsia , Capilares/metabolismo , Colágeno/metabolismo , Microanálisis por Sonda Electrónica , Epidermis/anatomía & histología , Epidermis/química , Fluconazol/administración & dosificación , Fluconazol/análisis , Humanos , Cuerpos de Inclusión/química , Cuerpos de Inclusión/metabolismo , Cuerpos de Inclusión/ultraestructura , Queratinocitos/química , Queratinocitos/citología , Queratinocitos/metabolismo , Masculino , Microscopía Electrónica , Persona de Mediana Edad , Glándulas Sebáceas/anatomía & histología , Glándulas Sebáceas/química , Glándulas Sebáceas/metabolismo , Sebo/metabolismo , Piel/anatomía & histología , Piel/química , Análisis Espectral , Sudor/metabolismo , Glándulas Sudoríparas/anatomía & histología , Glándulas Sudoríparas/química , Glándulas Sudoríparas/metabolismoRESUMEN
A patient who presented with severely decreased bilateral vision was found to have syphilis and neurosyphilis that responded well to a 14-day course of penicillin and prednisone. The patient tested positive for HIV, which can alter the natural course of syphilis, often making the diagnosis and treatment difficult. Conventional therapy for syphilis may not be effective in patients with HIV. Any patient with syphilis who is in a high-risk group should be tested for HIV; conversely, any patient with HIV should be tested for syphilis if signs or suspicions exist.
Asunto(s)
Oftalmopatías/complicaciones , Infecciones por VIH/complicaciones , Neurosífilis/complicaciones , Neurosífilis/diagnóstico , Adulto , Angiografía , Quimioterapia Combinada , Oftalmopatías/diagnóstico , Oftalmopatías/tratamiento farmacológico , Oftalmopatías/microbiología , Humanos , Masculino , Neurosífilis/tratamiento farmacológico , Penicilinas/administración & dosificación , Penicilinas/uso terapéutico , Prednisona/administración & dosificación , Prednisona/uso terapéutico , Serodiagnóstico de la Sífilis , Zidovudina/administración & dosificación , Zidovudina/uso terapéuticoRESUMEN
OBJECTIVE: To demonstrate that repetitive hand or wrist series could be minimized with minor refinements of triage. POPULATION: 2,119 consecutive trauma patients requiring hand or wrist series. METHOD: In baseline phase I, radiographs were ordered by triage corpsmen. In phase II, RNs or physicians performed triage and ordered films. Phase III followed inservice training on strategies to minimize duplicate studies. Phase IV required the RN or physician to provide written justification for duplicate studies. The number of duplications in each phase were compared to baseline using the chi-square test of homogeneity. RESULTS: The phase I duplication rate was 10.8%. In phase II, the percentage of duplicate studies was 8.1% (p = 0.12). Phase III decreased duplication to 6.2% (p < 0.01). Phase IV decreased duplicate studies to 5.8% (p < 0.01). CONCLUSION: In an emergency room generating over 180 hand and wrist studies monthly, minor changes in ordering practices reduced the duplication rate from 10.8% to 5.8%.
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Servicios Médicos de Urgencia/economía , Traumatismos de la Mano/diagnóstico por imagen , Mal Uso de los Servicios de Salud/economía , Medicina Militar , Traumatismos de la Muñeca/diagnóstico por imagen , Hospitales Militares , Humanos , Pautas de la Práctica en Medicina/economía , Radiografía , Estados UnidosAsunto(s)
Adenoma/diagnóstico por imagen , Neoplasias Óseas/diagnóstico por imagen , Hiperparatiroidismo/complicaciones , Osteítis Fibrosa Quística/diagnóstico por imagen , Neoplasias de las Paratiroides/diagnóstico por imagen , Adulto , Neoplasias Óseas/secundario , Diagnóstico Diferencial , Femenino , Humanos , Radiografía , Cintigrafía , Medronato de Tecnecio Tc 99mRESUMEN
Ochronosis, the musculoskeletal manifestation of alkaptonuria, primarily involves the larger joints of the body, including the spine. Ankylosis of the thoracolumbar spine leads to progressive loss of flexibility. The case described is that of a 72-year-old man with ochronosis who suffered a hyperextension injury to his spine in a fall, resulting in a fracture through an ankylosed L2-L3 disk space. To the authors' knowledge, this is the first reported fracture of an ankylosed ochronotic spine.
Asunto(s)
Vértebras Lumbares/lesiones , Ocronosis/complicaciones , Fracturas de la Columna Vertebral/etiología , Anciano , Humanos , Vértebras Lumbares/diagnóstico por imagen , Masculino , Radiografía , Fracturas de la Columna Vertebral/diagnóstico por imagenRESUMEN
[4-18F]Fluconazole was used to measure the pharmacokinetics of fluconazole in normal and infected animals. The biodistribution of fluconazole was determined after administration of the 18F-tracer with/without a pharmacological dose of unlabeled drug by radioactivity measurements on excised tissues. In normal rabbits and rabbits with candidal infection of the thigh, tissue concentrations of drug were determined by serial positron emission tomographic imaging. In rats, coinjection of tracer quantities of [4-18F]fluconazole with a pharmacological dose of unlabeled drug resulted in a relatively uniform distribution of radioactivity in most organs, whereas, when the 18F-tracer was injected alone, spleen, muscle and heart accumulation was decreased and liver accumulation was increased. In rabbits, this effect was less pronounced. Early accumulation of [4-18F]fluconazole was greater in infected muscle. The areas under the 2-hr uptake curves were 4.30 and 6.05 micrograms.hr.ml-1 for normal and infected tissue. A mathematical model was used to summarize the kinetics of fluconazole in normal and infected muscle. The model hypothesizes that fluconazole is compartmentalized in blood and tissue, with rate constants describing the transition between compartments. Direct measurement of the partition coefficient of fluconazole in muscle and predictions of the kinetic model were in close agreement, suggesting that fluconazole enters muscle via a passive transport mechanism. Transport rates of fluconazole, into (Kin) and out of tissue (kout), were increased in infected compared with normal muscle, possibly due to increased capillary permeability (Kin: 0.064 +/- 0.001 vs. 0.0270 +/- 0.0002, kout: 0.063 +/- 0.002 vs. 0.035 +/- 0.001).
Asunto(s)
Candidiasis/metabolismo , Fluconazol/farmacocinética , Animales , Estabilidad de Medicamentos , Radioisótopos de Flúor , Masculino , Modelos Biológicos , Conejos , Ratas , Ratas Endogámicas , Tomografía Computarizada de EmisiónRESUMEN
We developed a conjunctival wound closure technique with the idea of decreasing the incidence of wound leak following glaucoma filtration surgery. A micropoint 9-0 nylon vascular needle is used as a running mattress suture to close the limbal conjunctiva in routine fornix-based flap trabeculectomy surgery, trabeculectomy surgery with 5-fluorouracil (5-FU), and combined cataract and trabeculectomy surgery. In a series of 52 eyes in 52 patients in which we used this technique, there have been no cases of flat anterior chamber or significant choroidal effusion, complications often occurring secondary to trabeculectomy which require further intervention.
Asunto(s)
Conjuntiva/cirugía , Glaucoma/cirugía , Técnicas de Sutura , Trabeculectomía , Extracción de Catarata , Fluorouracilo/uso terapéutico , Glaucoma/tratamiento farmacológico , Humanos , Dehiscencia de la Herida Operatoria/prevención & controlRESUMEN
Candida albicans is an opportunistic pathogen of human mucosal surfaces. Colonization of oral and vaginal mucosa by this yeast is antagonized by the resident normal bacterial population. However, antibacterial therapy can alter the normal flora to allow fungal cells to attach, grow and invade host tissues. We studied the antimicrobic activity of fluconazole against clinical isolates of oral and vaginal bacteria and Candida albicans in vitro and in vivo by scanning and transmission electron microscopy; we also compared the bactericidal activity of fluconazole with clotrimazole in vitro by microbiologic assay. Fluconazole lysed fungi but did not change the ultrastructure of bacteria. Clotrimazole, but not fluconazole, was bactericidal against lactobacillus and streptococcus, the principal species of the oral and vaginal cavities. We conclude that Candida albicans, but not oral and vaginal bacteria, is susceptible to fluconazole. These observations help explain the antimycotic specificity of fluconazole and its efficacy against candidiasis in humans.
Asunto(s)
Candida albicans/efectos de los fármacos , Fluconazol/farmacología , Candida albicans/ultraestructura , Clotrimazol/farmacología , Femenino , Humanos , Lactobacillus/efectos de los fármacos , Microscopía Electrónica , Microscopía Electrónica de Rastreo , Mucosa Bucal/microbiología , Membrana Mucosa/microbiología , Especificidad de la Especie , Streptococcus/efectos de los fármacos , Vagina/microbiologíaRESUMEN
Epidemiologic studies have demonstrated a strong association between human immunodeficiency virus (HIV) and syphilitic infection. Recent reports have suggested that concurrent HIV and luetic infection may lead to an accelerated and more fulminant course of syphilis. Specifically, neurosyphilis is encountered much earlier in such patients. We report two cases in which both neurosyphilis and ocular syphilis were present in HIV sero-positive patients. A review of the literature reveals that 11 of 13 (85%) HIV-infected patients with ophthalmic syphilis also had neurosyphilis. In patients who present with signs of ocular inflammation and pose a diagnostic dilemma, syphilis and possible concurrent HIV infection merit strong consideration. We wish to emphasize that patients should be evaluated for the presence of neurosyphilis if co-infection exists. Ophthalmologists should be aware that neuro-ophthalmic lues may prove to be the presenting feature of infection with HIV.
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Infecciones Bacterianas del Ojo/complicaciones , Infecciones por VIH/complicaciones , Neurosífilis/complicaciones , Sífilis/complicaciones , Adulto , Amoxicilina/uso terapéutico , Infecciones Bacterianas del Ojo/diagnóstico , Infecciones Bacterianas del Ojo/tratamiento farmacológico , Fondo de Ojo , Seropositividad para VIH/diagnóstico , Humanos , Masculino , Neurosífilis/diagnóstico , Neurosífilis/tratamiento farmacológico , Penicilina G/uso terapéutico , Sífilis/diagnóstico , Sífilis/tratamiento farmacológico , Serodiagnóstico de la Sífilis , Agudeza VisualRESUMEN
The forming surfaces of enamel of rat incisors were examined by scanning electron microscope one hour after injection of either 5 mg/100 g body weight of sodium fluoride or 12 mg/100 g body weight of cobalt chloride. The cell debris from the surfaces of the separated incisors was either gently wiped off with soft facial tissues or chemically removed by treating with NaOH, NaOCl or trypsin. Best results to remove cell debris were obtained from 0.25% trypsin treatment. SEM studies revealed that the surface of the normal secretory enamel was characteristic in appearance with well-developed smooth prism outlines. In fluoride specimens the prism outlines were feathery in appearance, laced with protruding spine-shaped clusters of mineral crystals. In the case of cobalt treatment, prism outlines were less uniform and in some areas they were incomplete. The calcium concentration of surface enamel was significantly lower in the cobalt-treated specimens than those from control and fluoride-treated animals. The Ca:Mg ratio was also lower in cobalt-treated specimens as compared to control and fluoride-treated ones.
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Cobalto/farmacología , Esmalte Dental/efectos de los fármacos , Fluoruro de Sodio/farmacología , Animales , Esmalte Dental/ultraestructura , Microanálisis por Sonda Electrónica , Liofilización , Incisivo , Masculino , Microscopía Electrónica de Rastreo , Ratas , Ratas Endogámicas , TripsinaRESUMEN
The energy expenditure and gait characteristics of eleven subjects who had a unilateral arthrodesis of the hip and ten subjects who had a unilateral arthrodesis of the ankle were measured during a twenty-minute walking trial. Oxygen consumption was determined and heart rate, respiratory rate, and step frequency were monitored. The average walking speed for both groups was sixty-seven meters per minute, which is 84 per cent of normal gait velocity. After an arthrodesis of the ankle, the average rate of oxygen consumption was 12.0 milliliters per kilogram of body weight per meter, which is 3 per cent more than normal. The oxygen cost averaged 0.166 milliliter per kilogram per meter, resulting in a gait efficiency of 90 per cent. After arthrodesis of the hip, the mean rate of oxygen consumption was 14.9 milliliters per kilogram of body weight per meter, which is 32 per cent greater than normal. The oxygen cost, 0.223 milliliter per kilogram per meter, represented a gait efficiency of 53 per cent. The physiological energy expenditure by the subject after an arthrodesis of the hip was found to be significantly greater than after an arthrodesis of the ankle and was more than that reported previously after a total hip arthroplasty for unilateral degenerative disease.
Asunto(s)
Articulación del Tobillo/cirugía , Artrodesis , Metabolismo Energético , Articulación de la Cadera/cirugía , Adulto , Anciano , Antropometría , Marcha , Frecuencia Cardíaca , Humanos , Persona de Mediana Edad , Oxígeno/fisiología , RespiraciónRESUMEN
The economic consequences of antibiotic prophylaxis and therapy for bacterial infections in humans are profound. The reduction in real-dollar terms in the amount of illness and disability resulting from the use of developed and marketed antibiotics far outweighs costs of adverse effects, including resistance. Although bacterial infections continue to cause substantial mortality and morbidity worldwide, standard criteria for assessing the relation of infection to death or the contribution of resistance to mortality and morbidity do not exist. While local outbreaks of resistance may have serious consequences, bacterial susceptibility to antimicrobial therapy has remained virtually unchanged nationally where studied. Nevertheless, discriminating use of antimicrobial agents is held widely to be the keystone for minimizing resistance. It is not clear whether risk of selecting resistance is lowered by current community or clinical practices. Some analysts concentrate on the "problem" and "cost" of resistance and forget the benefits of the use of antibiotics. Development of resistance is a natural consequence of antibiotic use, but further quantification of this relation is required. Reports that resistance is increasing worldwide have presented a scientific challenge and economic opportunity to the pharmaceutical industry for the development of new antimicrobial agents. However, if a reasonable rate of return cannot be foreseen, capital for research and development is likely to be invested in areas that appear more financially attractive.
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Antibacterianos/uso terapéutico , Infecciones Bacterianas/economía , Industria Farmacéutica/economía , Infecciones Bacterianas/tratamiento farmacológico , Costos y Análisis de Costo , Farmacorresistencia Microbiana , Utilización de Medicamentos/economía , Humanos , Legislación de Medicamentos , Comercialización de los Servicios de SaludRESUMEN
The acute retinal necrosis (ARN) syndrome is a morphologically defined necrotizing retinitis, occurring in apparently otherwise healthy patients. It has been shown that the varicella zoster virus is at least one cause of the ARN syndrome; treatment with acyclovir has proven to be effective for the infectious component of ARN. We report three immunocompromised patients who developed cutaneous herpes zoster and a necrotizing retinitis that was morphologically similar to the ARN syndrome. All three patients responded promptly to treatment with acyclovir, an agent highly effective against varicella zoster and herpes simplex viruses, but ineffective in the treatment of cytomegalovirus. While cytomegalovirus retinitis is more common in immunocompromised patients, these patients may occasionally develop an ARN-like retinitis, presumably as a result of the varicella zoster virus, which responds to treatment with acyclovir.
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Herpes Zóster , Tolerancia Inmunológica , Retinitis/etiología , Aciclovir/uso terapéutico , Adulto , Humanos , Masculino , Persona de Mediana Edad , Retinitis/tratamiento farmacológico , Retinitis/patologíaRESUMEN
The acute retinal necrosis (ARN) syndrome has been recently linked to intraocular infection with one or more members of the herpesvirus family. The authors report two cases of ARN following herpes zoster skin eruptions, and one case following ipsilateral facial nerve palsy (Ramsay Hunt syndrome). Evaluation of serial serum antibody titers against cytomegalovirus (CMV), herpes simplex virus (HSV) (types 1 and 2), and varicella zoster (VZ) virus revealed diagnostic changes for VZ virus alone following the retinitis. Immune precipitation of radiolabeled VZ proteins by these sera followed by gel fractionation yielded radioimmune precipitation profiles characteristic of a recent zoster reactivation. These cases further implicate a central role for VZ virus infection in the etiology of the ARN syndrome.
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Dermatitis/etiología , Herpes Zóster , Enfermedades de la Retina/etiología , Enfermedad Aguda , Adulto , Dermatitis/complicaciones , Femenino , Herpes Zóster/inmunología , Herpes Zóster/patología , Humanos , Masculino , Persona de Mediana Edad , Necrosis , Enfermedades de la Retina/patología , Serología , SíndromeRESUMEN
The authors have developed a primate model for evaluating cytoprotection against alcohol-induced injury in gastric mucosa pretreated with antiulcer agents. In the present study, groups of squirrel monkeys received either a single oral dose of misoprostol (500 or 200 micrograms/kg), cimetidine (3 or 6 mg/kg), placebo, or no treatment. After 30 min, 1 ml of 50% ethanol was administered to all animals, except for one of two untreated controls. At 90 min, stomachs from lethally anesthetized primates were processed for scanning electron and quantitative stereoscopic microscopy. Fifty percent ethanol alone damaged epithelial cells and produced submucosal hemorrhagic lesions. Pretreatment with misoprostol limited alcohol-induced injury to superficial erosion of epithelial cells. Cimetidine did not protect the mucosa against ethanol-induced injury. We conclude that misoprostol-conferred cytoprotection in primate gastric mucosa correlates with the endoscopic findings by others that misoprostol, but not cimetidine, protected human stomach against alcohol-induced injury.
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Alprostadil/análogos & derivados , Antiulcerosos/farmacología , Cimetidina/farmacología , Etanol/toxicidad , Mucosa Gástrica/efectos de los fármacos , Alprostadil/farmacología , Animales , Membrana Basal/efectos de los fármacos , Membrana Basal/ultraestructura , Femenino , Mucosa Gástrica/patología , Mucosa Gástrica/ultraestructura , Microscopía Electrónica de Rastreo , Misoprostol , Placebos , SaimiriRESUMEN
A fast semi-automated method is described for labeling the antibiotic, erythromycin A (1), with the short-lived positron-emitting radionuclide, 11C (t 1/2 = 20.4 min), in order to permit the non-invasive study of its tissue uptake in vivo. Labelling was achieved by the fast reductive methylation of N-demethylerythromycin A (2) with [11C]formaldehyde, itself prepared from cyclotron-produced [11C]-carbon dioxide. Rapid chemical and radiochemical purification of the [N-methyl-11C]erythromycin A (3) were achieved by HPLC and verified by TLC with autoradiography. The purified material was formulated for human i.v. injection as a sterile apyrogenic solution of the lactobionate salt. The preparation takes 42 min from the end of radionuclide production and from [11C]carbon dioxide produces [N-methyl-C11]erythromycin A lactobionate in 1-12% radiochemical yield, corrected for radioactive decay.
Asunto(s)
Radioisótopos de Carbono , Eritromicina/análogos & derivados , Claritromicina , Marcaje Isotópico/métodosRESUMEN
The distribution of orally administered nitrofurantoin macrocrystals in the urinary tract was studied by whole body radioautography in female squirrel monkeys and by bioautography of excised human kidney. The drug was rapidly absorbed and widely distributed throughout the simian urinary tract and human kidney. Concentrations of 14C drug in simian renal cortex and renal pelvis were up to 5 times plasma levels. Nitrofurantoin-derived antibacterial activity was observed by bioautography throughout sections of human kidney at concentrations that killed susceptible human urinary tract pathogens.