Biometry accuracy using zero- and negative-powered intraocular lenses.

Purpose: To audit the accuracy of biometry using the SRK/T formula when negative- or zero-powered intraocular lenses (IOLs) are predicted and to compare the results between A-scan, B-scan, and optical methods of biometry.

Setting: Moorfields Eye Hospital, London, United Kingdom.

Methods: This retrospective analysis comprised 78 eyes of 54 patients having cataract surgery with zero- or negative-powered IOLs.

Delayed atrophy of the retinal pigment epithelium after submacular surgery.

Purpose: We report a case of delayed atrophy of the retinal pigment epithelium (RPE) eighteen months after apparently successful excision of submacular choroidal new vessels (CNV) in a patient with age-related macular degeneration (AMD).

Methods: Case report.

Results: Submacular surgery for CNV was achieved without visible disturbance of the underlying RPE in an 83 year old man diagnosed with AMD.

National surveillance of antimicrobial resistance in Pseudomonas aeruginosa isolates obtained from intensive care unit patients from 1993 to 2002.

Nosocomial infections caused by Pseudomonas aeruginosa in critically ill patients are often difficult to treat due to resistance to multiple antimicrobials. The purpose of this study was to evaluate antimicrobial resistance among P. aeruginosa isolates from intensive care unit patients in the United States from 1993 to 2002 by using the Intensive Care Unit Surveillance Study database.

The role of vasopressin in vasodilatory septic shock.

Septic shock that requires therapy with adrenergic agents is associated with high rates of mortality. Inappropriately normal or low serum concentrations of vasopressin contribute to the development of hypotension during sepsis. We critically evaluated the role of administering exogenous vasopressin to patients with septic shock.

Surveillance of multi-drug resistant Pseudomonas aeruginosa in an urban tertiary-care teaching hospital.

Antimicrobial resistance in Pseudomonas aeruginosa is a serious clinical problem. To determine the incidence of multi-drug resistant P. aeruginosa, resistance rates of P.

Effects of continuous vasopressin infusion in patients with septic shock.

Background: Small studies have reported that vasopressin improves hemodynamic instability in patients with septic shock.

Objective: To determine whether vasopressin infusion increases blood pressure, decreases catecholamine vasopressor use, and improves renal function in a large patient population with septic shock when used in a clinical setting.

Methods: A retrospective chart audit was conducted of critically ill patients who received vasopressin infusion for septic shock from January 2000 through September 2002.

Use of exogenous erythropoietin in critically ill patients.

Objective: Review the literature regarding the use of recombinant human erythropoietin (rHuEPO) to prevent red blood cell (RBC) transfusion in critically ill patients.

Data Sources: A computerized search of MEDLINE and EMBASE from 1966 through June 2003 was conducted using the terms erythropoietin, anemia, hemoglobin, critical care, intensive care, surgery, trauma, burn, and transfusion. References of selected articles were reviewed.

Duration of antimicrobial therapy for nosocomial pneumonia: possible strategies for minimizing antimicrobial use in intensive care units.

Objective: To review published data evaluating shorter courses of antibiotic therapy for nosocomial pneumonia and provide recommendations for minimizing antimicrobial use in intensive care units.

Data Source: Literature was identified through MEDLINE (1966 through 6/2002) and a manual search of critical care, infectious disease, and pharmacy journals was conducted to identify relevant abstracts.

Data Synthesis: Antibiotic use may be decreased by discontinuing therapy after 3 days in patients with low likelihood of nosocomial pneumonia.

Proton-pump inhibitors for stress ulcer prophylaxis in critically ill patients.

Objective: To evaluate the use of proton-pump inhibitors (PPIs) for stress ulcer prophylaxis in critically ill adults.

Data Sources: Computerized biomedical literature search of MEDLINE (1966-June 2002) was conducted using the MeSH headings proton-pump inhibitor, ulcer, critical care, and acid. References of selected articles were reviewed.

Stress-dose corticosteroid therapy for sepsis and acute lung injury or acute respiratory distress syndrome in critically ill adults.

Sepsis and acute lung injury (ALI) or acute respiratory distress syndrome (ARDS) are associated with high mortality rates despite recent therapeutic advances. Both disease states involve uncontrolled host defense responses that lead to inflammation, endothelial damage, enhanced coagulation, diminished fibrinolysis and fibroproliferation to produce microthrombi, and relative adrenal insufficiency. Corticosteroids inhibit the host defense response and may offer an inexpensive therapeutic option.

Spontaneous foreign body extrusion following perforating eye injury.

A structured approach to the management of a perforating ballistic eye injury is illustrated in this case, where initial treatment was limited to simple corneal wound closure and antibiotic prophylaxis. A pellet had passed completely through the globe but the retina remained attached, and it was decided to manage the case conservatively. Two retained foreign bodies were extruded spontaneously some months after the injury when suture removal and delayed cataract surgery led to a virtually perfect visual outcome.

Use of enteral nutrition for stress ulcer prophylaxis.

Objective: To review the controversies involving the use of enteral nutrition support for stress ulcer prophylaxis and formulate recommendations.

Data Sources: A MEDLINE search (1966-December 2000) was conducted using the MeSH of nutrition, ulcer, critical care, and acid to identify relevant articles. References of selected articles were reviewed, and relevant abstracts from critical care or gastrointestinal journals identified.

Comparison of cisapride and metoclopramide for facilitating gastric emptying and improving tolerance to intragastric enteral nutrition in critically III, mechanically ventilated adults.

Background: Placebo-controlled studies have indicated that both cisapride and metoclopramide promote gastric motility in critically ill patients.

Objective: This study was conducted to compare cisapride and metoclopramide for facilitating gastric emptying and improving tolerance to intragastric enteral nutrition (EN) and to evaluate the relationship between aspirated gastric residual volume and gastric emptying function in this patient population.

Methods: In this double-blind study, critically ill, mechanically ventilated patients with an aspirated gastric residual volume > or = 150 mL while receiving intragastric EN were randomized to receive enteral cisapride 10 mg or metoclopramide 10 mg every 6 hours for a total of 7 doses.

Enteral methadone to expedite fentanyl discontinuation and prevent opioid abstinence syndrome in the PICU.

Study Objective: To determine if enterally administered methadone can facilitate fentanyl discontinuation and prevent withdrawal in children at high risk for opioid abstinence syndrome.

Design: Retrospective analysis.

Setting: Pediatric intensive care unit (PICU) in a tertiary care children's hospital.

Evaluation and survey of intravenous vitamin K1 for treatment of coagulopathy in critically ill patients.

Study Objectives: To determine patient factors associated with coagulopathy, to assess variables affecting response to vitamin K1, to describe vitamin K1-associated adverse reactions, and to survey Canadian tertiary care hospitals about vitamin K1 practice patterns in their intensive care units (ICUs).

Design: Retrospective chart audit and prospective survey.

Setting: Medical-surgical ICU with a 23-bed complement in a tertiary care, university-affiliated hospital, and 47 Canadian tertiary care hospitals.

Intolerance to intragastric enteral nutrition in critically ill patients: complications and management.

Compared with parenteral nutrition, early administration of enteral nutrition (EN) to critically ill patients improves clinical outcomes and reduces infection rates. Intragastric EN often is complicated by intolerance, as indicated by elevated volumes of aspirated gastric residuals. Conflicting data are available for the volume of residual that represents intolerance, but most clinicians use 150-200 ml to signify gastrointestinal motility dysfunction.

A prospective evaluation of empiric versus protocol-based sedation and analgesia.

Study Objective: To compare empiric and protocol-based therapies of sedation and analgesia in terms of pharmacologic cost, effects on mechanical ventilation and intensive care unit (ICU) stay, and quality of sedation and analgesia.

Design: Prospective study.

Setting: A 24-bed medical-surgical-neurologic ICU.

Sequential single doses of cisapride, erythromycin, and metoclopramide in critically ill patients intolerant to enteral nutrition: a randomized, placebo-controlled, crossover study.

Objective: To evaluate the comparative efficacy of enteral cisapride, metoclopramide, erythromycin, and placebo for promoting gastric emptying in critically ill patients with intolerance to gastric enteral nutrition (EN).

Design: A randomized, crossover study.

Setting: Adult medical intensive care unit at a university-affiliated private hospital and trauma intensive care unit at a university teaching hospital.

Re-establishment of visual circuitry after optic nerve regeneration.

In mammals there are a few circumstances in which axotomised ganglion cell axons can regenerate. For instance, in vitro explants of retina can be encouraged to regenerate axons into appropriate culture media. Similarly, axotomised ganglion cells can regenerate into a peripheral nerve graft surgically connected to the optic nerve head, and during early development axons are able to regenerate across the retina to re-enter the optic nerve.

Respiratory failure following oral administration of metoclopramide.

Objective: To report a case of respiratory failure, possibly due to anaphylaxis or asthma exacerbation, following the administration of metoclopramide.

Case Summary: A 32-year-old white woman with a history of severe asthma and short-bowel syndrome was admitted for Hickman catheter line sepsis. Two doses of oral metoclopramide 10 mg in solution were administered for nausea and vomiting.

Regeneration and transplantation of the optic nerve: developing a clinical strategy.

Three separate experimental models of optic nerve regeneration have been presented--along the existing pathway in the presence of antibodies to neutralise inhibitory molecules, along peripheral nerve grafts and from retinal transplants. Each offers a theoretical clinical strategy for restoration of vision, if the mechanism of re-establishment of maps and reconnection to appropriate targets during regeneration can be determined. This is the process of axon guidance, and underlines the importance of our research into the molecular determinants that guide normal development of the visual system.