National audit of the outcome of primary surgery for rhegmatogenous retinal detachment. II. Clinical outcomes.

Purpose: This national study was designed to audit anatomical outcome and complications relating to primary surgery for rhegmatogenous retinal detachments. This paper presents success and complication rates, and examines variations in outcome.

Methods: Sampling and recruitment details of this nationwide cross-sectional survey of 768 patients of 167 consultant ophthalmologists having their first operation for rhegmatogenous retinal detachment have been described.

National audit of the outcome of primary surgery for rhegmatogenous retinal detachment. I. Sample and methods.

Purpose: This national study was designed to audit anatomical outcome and complications relating to primary surgery for rhegmatogenous retinal detachments. This paper presents survey methods, characteristics of participating consultants and the demographic and clinical characteristics of the patient sample.

Methods: Two surveys were undertaken.

Nutrition and health (1948) of Aborigines in settlements in Arnhem Land, northern Australia.

During the American-Australian Scientific Expedition to Arnhem Land in 1948, a nutritionist (Margaret McArthur), a medical officer (Brian Billington), a biochemist (Kelvin Hodges) and also the 'flying dentist' (John Moody) observed the nutrition and health of Aborigines in the settlements on Groote Eylandt, at Yirrkala and at Oenpelli, Northern Territory. The results of their research were published in the Records of the American-Australian Scientific Expedition to Arnhem Land Volume 2 Anthropology and Nutrition. (Melbourne University Press, 1960).

Silent domains are assembled continuously from the telomere and are defined by promoter distance and strength, and by SIR3 dosage.

In Saccharomyces cerevisiae, telomeres repress transcription of genes located nearby. This region-specific gene inactivation is thought to involve the packaging of telomeric domains into silent chromatin. To gain insight into the mechanism of telomeric silencing, a genetic assay to examine the spread of silencing along the distal right arm of chromosome V was developed.

Modifiers of position effect are shared between telomeric and silent mating-type loci in S. cerevisiae.

Genes placed near telomeres in S. cerevisiae succumb to position-effect variegation. SIR2, SIR3, SIR4, NAT1, ARD1, and HHF2 (histone H4) were identified as modifiers of the position effect at telomeres, since transcriptional repression near telomeres was no longer observed when any of the modifier genes were mutated.

Position effect at S. cerevisiae telomeres: reversible repression of Pol II transcription.

S. cerevisiae chromosomes end with the telomeric repeat (TG1-3)n. When any of four Pol II genes was placed immediately adjacent to the telomeric repeats, expression of the gene was reversibly repressed as demonstrated by phenotype and mRNA analyses.

Immunoglobulins in paired specimens of vitreous and subretinal fluids from patients with rhegmatogenous retinal detachment.

Evidence suggests that there is a net movement of fluid through the retinal break in eyes with rhegmatogenous retinal detachment, this net movement being directed from the vitreous humour into the subretinal space. However, it remains uncertain how much fluid exchange occurs in both directions across such breaks. The concentration ratios of IgG/IgM or IgA/IgM, derived from assay of immunoglobulins in vitreous humour, subretinal fluid, and serum from a group of 19 such patients, suggest a lack of free, two-directional, fluid movement across the retinal break.

Vitrectomy and fluid/silicone-oil exchange for giant retinal tears: 5 years follow-up.

A series of 64 eyes, in 64 patients with giant retinal tears, treated by vitrectomy and fluid/silicone-oil exchange, has been reviewed after 5 years. Anatomical success was achieved in 73% of cases and visual function in successful cases ranged from 6/6 to NPL; 66% achieved acuities of 6/60 or better and 32% had vision of 6/18 or better. These results compare favourably with those in a previous series reported after 6 months and 18 months.

Role of maintenance sucralfate in prevention of duodenal ulcer recurrence.

Fifty-nine patients who had duodenal ulcers that were healed following sucralfate administration in a dose of 1 g four times a day were randomly entered into a double-blind, placebo-controlled, 12-month maintenance study to determine whether sucralfate 1 g twice daily prevents recurrence of duodenal ulceration. Patients were assessed endoscopically at four, eight, and 12 months after healing or earlier if clinical relapse occurred. Of the original 59 patients, 53 showed healing with six weeks of therapy, and the remaining six patients required 10 weeks of treatment.

Prevention of duodenal ulcer occurrence. Double-blind comparison of ranitidine and cimetidine.

We compared ranitidine and cimetidine in maintenance therapy to prevent duodenal ulcer recurrence over a period of 24 months. Endoscopic examination at the end of 12 months showed that the ulcers of 26 of 31 patients (84%) on ranitidine in a dose of 150 mg remained healed and of 10 of 13 (77%) patients on cimetidine in a dose of 400 mg at night remained healed. Thirty-four patients continued in an open evaluation of ranitidine in a dose of 150 mg at night for a further 12-month period, and during this time there were four further recurrences.

Pars plana vitrectomy for retinal detachment with unseen retinal holes.

A study was made of a consecutive series of 47 cases of rhegmatogenous retinal detachment treated by pars plana vitrectomy in which no holes were identified preoperatively. The view of the fundus during preoperative examination varied from being totally clear to completely obscured by media opacities. The role of pars plana vitrectomy in finding retinal holes peroperatively is considered.

Vitrectomy and fluid/silicone-oil exchange for giant retinal tears: results at 18 months.

Sixty-five eyes with giant retinal tears previously reviewed at 6 months after vitrectomy and fluid/silicone-oil exchange were again reviewed 18 months after surgery. The retina remained attached in 54 eyes (83%), and of these 32 (57%) had visual acuities of 6/60 or better. Poor acuities were attributed in most cases to cataract associated with silicone-oil contact or macular damage from preoperative macular detachment.

The treatment of macular holes by pars plana vitrectomy and internal air/SF6 exchange.

The results of a series of patients with full-thickness macular holes treated by pars plana vitrectomy are described. A air/gas mixture is used to tamponade the retinal hole and no adhesion is applied. Eleven eyes, including six high myopes, were treated using this method and sustained reattachment was achieved in eight eyes (73%).

Management of retinal detachment in the Wagner-Stickler syndrome.

Thirty six retinal detachments in 33 patients with Wagner-Stickler syndrome are reported. The results of surgery are correlated with the types of break (giant retinal tear or multiple breaks), the surgical approach (conventional buckling or closed microsurgery) and the presence or absence of proliferative vitreoretinopathy. Overall, 27 detachments were successfully reattached.

Treatment of rhegmatogenous retinal detachment uncomplicated by massive periretinal proliferation by pars plana vitrectomy.

Pars plana vitrectomy was used to treat rhegmatogenous retinal detachment in 12 cases of macular hole and 27 cases with incomplete massive periretinal proliferation. The surgical success rate and visual outcome are discussed.

Residents' functioning and staff perceptions of 'ease of management' in two types of old peoples' homes.

Two hundred and forty-five residents in six old peoples' homes of different types were assessed for level of confusion, behavioural disturbance and whether they were most or least difficult to manage. Results show that: Residents in non-unit homes differ from those in unit establishments studied in being significantly more confused and behaviourally disturbed. EMI residents are more confused than non-EMI.

Miniprobe for lacrimal sac temperature measurement.

The hypodermic probe is presented as a portable and easily used instrument for assessing the temperature within the lacrimal drainage system. Its size makes it practical for clinic or office use. It is also acceptable to the patient and may be performed immediately prior to lacrimal syringings.

The management of ascites using the Rhodiascit Apparatus ("Paris Pump").

The Rhodiascit Apparatus ("Paris Pump") which ultrafilters sodium and water from ascitic fluid allowing reinfusion of a protein-rich concentrate, has been found to be a valuable procedure in the management of ascites associated with liver cirrhosis. The device was evaluated in eight patients with the aim of rapidly controlling ascites with minimum hospitalisation. The duration of the procedure varied from 8.