Surgical management of complete blepharoptosis with no levator function from a compressive third nerve palsy.

A 94-year-old monocular woman with a posterior communicating artery aneurysm developed a compressive third nerve palsy with complete blepharoptosis and abduction of her seeing eye. It was believed that she was not a good neurosurgical candidate for aneurysm repair. Her ptosis was managed successfully with an in-office Whitnall sling procedure combined with a superior tarsectomy.

Oral gabapentin for the treatment of postoperative pain after photorefractive keratectomy.

Purpose: To evaluate oral gabapentin for postoperative pain after photorefractive keratectomy (PRK).

Design: Prospective, nonrandomized clinical trial.

Methods: In additional to a standard regimen of topical antibiotics, topical steroids, and topical tetracaine as required, all PRK patients at our laser vision center were treated after surgery for pain for a two-month period with Percocet (oxycodone/acetaminophen) [Endo Pharmaceuticals; Chadds Ford, Pennsylvania, USA] 5 mg/325 mg as required for three days (control group).

Accuracy, repeatability, and clinical application of spherocylindrical automated refraction using time-based wavefront aberrometry measurements.

Purpose: To evaluate the clinical utility of spherocylindrical automated refraction (AR) based on time-based wavefront technology compared with subjective manifest refraction (MR) for the purpose of prescribing eyeglasses.

Design: Prospective observational case series.

Participants: A convenience sample of 105 eyes of 53 patients (ages 19 to 87) with corrected acuity no worse than 20/40(-2).

Delayed-onset expulsive choroidal hemorrhage attributed to an acute elevation in systemic blood pressure following traumatic globe rupture.

The authors describe a 78-year-old woman who suffered a traumatic partial dehiscence of a penetrating keratoplasty on the day prior to presentation. While awaiting surgical repair, the patient experienced an expulsive choroidal hemorrhage necessitating a primary evisceration of the eye. This case is unique because the hemorrhage can be largely attributed to the acute dramatic rise in systemic blood pressure that immediately preceded it.

Critically reappraising the literature-driven practice of analgesia administration for acute abdominal pain in the emergency room prior to surgical evaluation.

Background: Classic teaching is that narcotic analgesia in the setting of an acute abdomen can alter physical examination findings and should therefore be withheld until after a surgeon's examination.

Methods: A telephone survey of emergency medicine physicians representing 60 US hospitals was conducted to assess the current practices and opinions regarding the early administration of narcotic analgesia in this setting. Relevant literature was also reviewed for methodological errors.

Spontaneous nontraumatic hemoperitoneum due to a bleeding arteriovenous malformation on the serosal surface of the transverse colon: a case report.

Arteriovenous malformations of the gastrointestinal tract are a very common entity and a frequently cited cause of lower gastrointestinal bleeding in adults. They are characteristically found in the mucosa or submucosa of the bowel wall, and the vast majority do not cause any symptoms. We discuss the rare case of an extraluminal arteriovenous malformation of the transverse colon in an elderly woman who presented to the emergency department in hypovolemic shock after collapsing at home.

The development of an interactive game-based tool for learning surgical management algorithms via computer.

Background: We have previously demonstrated the potential efficacy of a computer-assisted board game as a tool for medical education. The next logical step was to transfer the entire game on to the computer, thus increasing accessibility to students and allowing for a richer and more accurate simulation of patient scenarios.

Methods: First, a general game model was developed using Microsoft Visual Basic.