Management of the critically ill cardiac patient.

The decline in rheumatic fever has made heart disease in pregnancy an uncommon problem in the developed world but it remains an important cause of maternal morbidity and mortality in developing countries. Pregnancy is particularly dangerous in the presence of cyanotic congenital heart disease, Eisenmenger's syndrome, primary pulmonary hypertension, Marfan's syndrome, dilated cardiomyopathy and significant mitral stenosis. Severe stenosis is often complicated by pulmonary hypertension and atrial fibrillation.

Nimesulide, a balanced drug for the treatment of osteoarthritis.

World-wide experience with nimesulide confirms that it is an effective anti-inflammatory drug in the treatment of osteoarthritis. A review of several studies in this condition confirms that nimesulide is at least as efficacious as other commonly used compounds. The safety profile of nimesulide, compared to reference drugs such as naproxen, etodolac and diclofenac, demonstrates superior gastrointestinal tolerability.

Peripheral neuropathy associated with common variable immunodeficiency.

We report a patient with common variable immunodeficiency (CVID) who developed an axonal sensorimotor polyneuropathy, a hitherto unreported association to our knowledge. These conditions may be linked at the pathogenetic level, since some CVID patients are prone to the development of autoimmune disease.

Coeliac plexus block using computed tomography guidance.

Coeliac plexus blocks have been used successfully in the treatment of abdominal pain in advanced cancer and in benign chronic abdominal pain. However, concern remains about occasional potentially serious complications. One possible way to reduce the risks of this procedure may be to improve imaging during the procedure.

Erythroderma: a comparison between HIV positive and negative patients.

Unlabelled: Background Erythroderma has protean underlying causes. There have been isolated case reports suggesting an association between erythroderma and the human immunodeficiency virus (HIV).

Objective: To describe and characterize further the prevalence, etiology, and metabolic sequelae of erythroderma in HIV positive and negative patients.

Can I drive after those drops, doctor?

Purpose: To document the experience of patients driving after drops to dilate the pupils. There are no documented guidelines on driving after pupillary dilatation. This is a study of patients who drove a car after attending the eye casualty for an ocular examination during which their pupils were dilated.

Estimation of the retinal nerve fibre layer thickness in the papillomacular area of long standing stage IV macular holes.

Aim: To compare the thickness of the retinal nerve fibre layer (RNFL) in the papillomacular area of patients with long standing stage IV macular holes with age matched controls, using a scanning laser polarimeter.

Methods: The nerve fibre analyser (NFA) was used to measure the mean thickness of the RNFL around the optic nerve head, the thickness values of temporal and nasal 45 degrees sectors and the integral values in 10 patients with macular holes and in 10 age matched controls.

Results: The mean RNFL thickness around the optic nerve head was 79.

Surgically induced necrotizing scleritis in a patient with ankylosing spondylitis.

We present the case of a 75-year-old man with ankylosing spondylitis who developed surgically induced necrotizing scleritis (SINS) more than 3 years after uneventful extracapsular cataract extraction and posterior chamber intraocular lens implantation. The patient presented with a painful eye and increasing vertical diplopia. To our knowledge, neither the association of SINS and ankylosing spondylitis nor vertical diplopia as its presenting complaint has been described.

Is the single use of intraoperative 5-fluorouracil in filtering surgery for high-risk cases enough?

Purpose: To study the efficacy of the adjunctive use of a single intraoperative application of 5-fluorouracil (5FU) in eyes with poor prognoses for a successful outcome with a trabeculectomy.

Method: Twenty-four patients (25 eyes) with a mean age of 63.7 +/- 14.

Acute pseudo-obstruction of the colon following left-sided total hip replacement: an analysis of five patients.

We report five cases of acute large bowel pseudo-obstruction following left-sided total hip replacement. All five cases presented with a similar sequence of clinical symptoms and physical signs. Acetabular trauma and heat generation from bone cement may lead to an imbalance of the autonomic nervous supply of the colon.

Wolfring dacryops and needling.

Cysts of the accessory lacrimal gland of Wolfring are uncommon in Europe; they are commoner in areas where trachoma is endemic and usually occur in eyes with some evidence of past trachomatous scarring (Bullock et al. 1986). The recommended mode of management is surgical, using an operating microscope, with an incision through the conjunctiva.

Case report: ultrasound diagnosis of polyorchidism.

A case of polyorchidism is presented where the ultrasound findings fulfilled all the criteria for the diagnosis of polyorchidism, with no evidence of an associated abnormality on clinical and ultrasound examinations. On the basis of these findings surgical exploration was not carried out.

The use of dynamic ultrasound B-scan to detect retinal tears in spontaneous vitreous haemorrhage.

The use of dynamic ultrasound B-scan to detect retinal tears in spontaneous vitreous haemorrhage is described. A 6-month prospective study was undertaken of non-diabetic patients who presented with spontaneous vitreous haemorrhage, in whom the fundus could not be visualised and in whom a rhegmatogenous aetiology was suspected. Patients were followed up at least weekly with repeat B-scans until adequate fundus visualisation was possible.

Mechanical back pain and the facet joint syndrome.

Mechanical back pain is a common disability often associated with the facet joint syndrome. Treatment is based on early, adequate pain relief with simple techniques of regional analgesia. In a few cases this is not enough and more sophisticated methods, such as radiofrequency denervation, cryo-analgesia and possibly intrathecal midazolam, are necessary.

Reduction in mydriatic drop size in premature infants.

In a prospective study of 26 premature infants, 5 microliters microdrops were compared with standard 26 microliters eye drops of cyclopentolate 0.5% and phenylephrine 2.5%.

Holmium laser sclerostomy: a clinical study.

A prospective study of 30 glaucoma patients (one eye in each patient) treated by an ab externo holmium laser sclerostomy is presented. An average of 40.2 pulses with an energy of 100 mJ was necessary to produce a filtering bleb.

Case report. Bee sting brachial block.

A case of brachial plexus block is presented, following a bee sting in the posterior triangle of the neck. The onset of neurological symptoms was rapid as was their subsequent resolution. Delayed peripheral neurological symptoms believed to have an immunological basis have been reported in response to stings from bees and other Hymenoptera both in the central and peripheral nervous systems (Goldstein et al.

Treatment of glaucoma following penetrating keratoplasty with transscleral YAG cyclophotocoagulation.

Thirteen patients with refractory glaucoma following penetrating keratoplasty were treated with 180 degree transscleral Neodymium: YAG cyclophotocoagulation. Intraocular pressures below 21 mmHg were achieved in nine patients (69%) with a mean follow up of 19.8 months.

Lensectomy for complicated cataract in juvenile chronic iridocyclitis.

Experience with the removal of complicated cataract by lensectomy in patients with juvenile chronic iridocyclitis (JCI) has so far been limited. The results of lensectomy were reviewed retrospectively in 131 patients with JCI (187 eyes). The mean follow up period was 5 years 4 months.

Ocular defects in infants of extremely low birth weight and low gestational age.

The eyes of 49 babies who weighed less than 1,000 g at birth or who were born at or before 28 weeks gestation were examined at the age of 4 years. Twenty-one children were normal. The remaining 29 children (59%) had ocular abnormalities which ranged from mild amblyopia to blindness from retinopathy of prematurity.