Vestibular Function Measurement Devices

Vestibular function laboratories utilize a multitude of diagnostic instruments to evaluate a dizzy patient. Caloric irrigators, oculomotor stimuli, and rotational chairs produce a stimulus whose accuracy is required for the patient response to be accurate. Careful attention to everything from cleanliness of equipment to threshold adjustments determine on a daily basis if patient data are going to be correct and useful. Instrumentation specifications that change with time such as speed and temperature must periodically be checked using calibrated instruments.     

Effect of Tropicamide on Laser Flare Meter Measurements in Patients with Pseudoexfoliation

ABSTRACT

Purpose

To investigate the effect of 1% tropicamide on anterior chamber aqueous flare (ACAF) measurements acquired with laser flare meter in patients with pseudoexfoliation.     

Acute total hip arthroplasty for older patients with acetabular fractures: A meta-analysis

ObjectiveMultiple treatment options for acetabular fractures in geriatric patients exist. However, no large-scale studies have reported the outcomes of acute total hip arthroplasty (THA) in this patient population. We systematically evaluated all available evidence to characterize clinical outcomes, complications, and revisions of acute THA for acetabular fractures in geriatric patients.MethodsMeta-analysis of 21 studies of 430 acetabular fractures with mean follow-up of 44 months (range, 17−97 months). Two independent researchers searched and evaluated the databases of Ovid, Embase, and United States National Library of Medicine using a Boolean search string up to December 2019. Population demographics and complications, including presence of heterotopic ossification (HO), dislocation, infection, revision rate, neurological deficits, and venous thromboembolic event (VTE), were recorded and analyzed.ResultsWeighted mean Harris Hip Score was 83.3 points, and 20% of the patients had reported complications. The most common complication was HO, with a rate of 19.5%. Brooker grade III and IV HO rates were lower at 6.8%. Hip dislocation occurred at a rate of 6.1%, 4.1% of patients developed VTE, deep infection occurred in 3.8%, and neurological complications occurred in 1.9%. Although the revision rate was described in most studies, we were unable to perform a survival analysis because the time to each revision was described in only a few studies. The revision rate was 4.3%.ConclusionsAcute THA is a viable option for treatment of acetabular fracture and can result in acceptable clinical outcomes and survivorship rates in older patients but with an associated complication rate of approximately 20%. Considering the limited treatment options, THA might be a viable alternative for appropriately selected patients.     

NA:YAG激光虹膜切除术治疗闭角型青光眼201例临床观察

目的评价NA：YAG激光虹膜切除术治疗原发性闭角型青光眼和葡萄膜炎继发青光眼的临床疗效。方法回顾分析192例219眼原发性闭角型青光眼和9例葡萄膜炎继发青光眼，接受NA：YAG激光虹膜切除术后的临床效果，随诊16—46月。结果激光切孔一次成功205眼（占89e），激光能量在11—17．1mJ，67％病例在22—84Mj，击射次数2-33次。葡萄膜炎继发青光眼9眼均二次激光后虹膜孔通畅。95．61％术后眼压正常，视野无变化，术后早期一过性眼压升高占34％，术中出血占36％，房角色素增加占47％，1例术后28月接受小量切除术，8例术后需配合使用降眼压药物控制眼压。结论NA：YAG激光虹膜切除术是一种治疗闭角型青光眼的安全有效的方法。术前掌握适应症，把握手术时机，充分的术前准备是手术成功的关键。     

腰椎节段形态对峡部、小关节应力及小关节接触力影响的有限元分析

目的:探讨腰椎形态结构变化对峡部裂性滑脱及小关节退变的作用和意义。方法:采用改良的“非种子区域分割方法”及非平行“最佳切割平面”等一系列新型计算机辅助设计(CAD)方法精确建立包括椎间盘高度、腰椎小关节角、椎间盘前凸角改变的L4~L5活动节段有限元模型;在2700N轴向压缩载荷条件下,分别对各有限元模型的峡部、小关节应力、小关节接触力以及椎间盘负载进行测试。结果:压缩载荷下,腰椎活动节段峡部、小关节等效应力及小关节接触力随椎间盘高度的减小而减小,随小关节角的增大而增加,随椎间盘前凸角的增加而减小。结论:椎间盘高度、腰椎小关节角、椎间盘前凸角等形态结构变化对腰椎节段有限元模型的峡部、小关节应力及小关节接触力有明显的影响。提示腰椎峡部应力性骨折及小关节退变的发生与椎间盘高度、腰椎小关节角、椎间盘前凸角等解剖形态因素有关。     

Detection of glaucomatous damage using multifocal ERG

The first‐order kernel analysis in multifocal electroretinogram (mfERG) using low contrast stimulation is suggested as a way to detect the inner retinal responses in animal studies. In this case report, this protocol is applied to human patients with glaucoma to demonstrate the possibility of using mfERG as a tool to detect glaucomatous damage. Two patients with glaucoma were recruited and had mfERG measurements with the 103‐scaled hexagonal stimulus pattern at low (50 per cent) contrast. Their responses were analysed and compared with those from normal subjects with the mfERG measured under the same condition. In the normal subjects, there were obvious oscillatory components on the ascending and descending limbs of the first‐order kernel response to 50 per cent contrast. In the glaucomatous patients, the oscillatory component on the descending limb was obviously diminished. In addition, this component was significantly diminished in the quadrant with a glaucomatous visual field defect. This suggests that the low‐contrast stimulation condition in mERG measurement may provide a good way to detect glaucomatous damage and this may help in clinical diagnosis of glaucoma.     

膝以下严重开放性创伤的修复

[目的]研究膝以下严重开放性创伤的修复。[方法]自1995年3月～2005年3月收治膝以下严重开放性损伤153例，Ⅰ期修复106例，Ⅱ期修复47例，7种内固定方法，11种皮瓣修复方法。[结果]153例中随访132例，时间6个月～5年，平均17个月，术后功能优良率85．7％，皮瓣成活率良好。皮瓣局部坏死25例，骨不连4例，慢性感染8例，骨髓炎3例。[结论]改进的腓肠神经营养血管皮瓣和皮瓣桥手术扩大了皮瓣的应用范围，减少了并发症的发生。本研究为膝以下严重开放性损伤的修复提供了良好的方法；熟练的显微外科技术和各种组织瓣的合理应用是修复成功的关键。     

改良开放性手术治疗巨大良性前列腺增生症

目的探讨巨大良性前列腺增生症的开放性手术治疗方法及效果。方法回顾分析16例巨大良性前列腺增生症,年龄61~88岁,平均74岁。作耻骨上经膀胱前列腺切除术。结果手术均成功;手术时间35~65min,出血量100~200mL,术后前列腺重量为200~520g,平均215g;膀胱冲洗2~3d,拔导尿管5~7d;术后3d再出血1例,经DSA同侧髂内血管栓塞止血成功,排尿困难1例,短期尿失禁1例,其余患者术后均排尿通畅,控尿良好。结论开放性手术治疗巨大良性前列腺增生症,其梗阻解除彻底,是一种合理的治疗方法。恰当的手术方法是提高疗效及降低并发症的关键。     

Photodynamic laser cyclodestruction with chloroaluminum sulfonated Phthalocyanine (CASPc) or photofrin®(PII) Vs. Nd:YAG laser cyclodestruction in a pigmented rabbit model

Background and Objective: To investigate Photofrin® (PII) and CASPc for photodynamic therapy (PDT) of the ciliary body in rabbits. Study Design/Materials and Methods: PII (10 mg/kg) or CASPc (1 mg/kg) was given by ear vein. Pharmacokinetics were studied in frozen sections by fluorescence microscopy (CCD camera based low light detection system with digital image processing) at 1 and 24 h (8 rabbits;16 eyes). Laser light was delivered (argon pumped dye laser;630 and 675 nm;8 rabbits;16 eyes) by contact fiberoptic. To compensate for iris attenuation, irradiance was 125 mW/cm² (20, 40, 80, or 160 J/cm²). Controls (4 rabbits;8 eyes) received laser light without photochemicals (OD) and for comparison, continuous wave Nd:YAG laser by fiberoptic (0.8–1.2J;OS). Results: Localization studies showed intravascular distribution with some selective ciliary body distribution at 24 h (PII > CASPc). Rabbits treated with PII or CASPc exhibited variable amounts of gross ciliary body edema, infarction, and necrosis by 24–48 h. This response was not seen in PDT control tissues;damage was seen in the iris and ciliary body, with partial vacuolization of the pigment epithelium. Conclusion: PDT may offer a more selective approach to ciliary body destruction. A small but significant thermal effect was seen during PDT from melanin photon uptake with damage to iris and ciliary body. Thermal damage and potential interaction with ocular visual pigments may limit use of these photochemicals and wavelengths for PDT of the ciliary body © 1995 Wiley-Liss, Inc.