Laser photomydriasis in pseudophakic pupillary block

Pupillary block glaucoma is a potential complication of implantation. Early recognition and prompt medical therapy will generally successfully treat the condition. In some instances surgical treatment is required if medical therapy is inadequate. Laser iridectomy and laser photomydriasis are other alternatives to surgical therapy. This case reports successful treatment of pseudophakic pupillary block glaucoma using laser photomydriasis.     

Laser iridectomy treatment of acute pseudophakic pupillary block glaucoma

A 71-year-old patient developed acute pupillary block glaucoma two years after uncomplicated extracapsular cataract surgery with primary implantation of a Choyce-style anterior chamber lens. He presented one week after the onset of pain. The attack was relieved with argon laser iridectomy. The presumed mechanism was rotation of the intraocular lens due to blunt trauma, occluding the previously patent single surgical iridectomy site. We felt that in this case, laser iridectomy was a good, safe alternative to surgical iridectomy.     

Massive pseudophakic pigment dispersion associated with an iris nevus

A 67-year-old woman examined 12 months following extracapsular cataract extraction had a massive pseudophakic pigment dispersion associated with diffuse corneal epithelial edema, mild uveitis, and secondary glaucoma. She underwent penetrating keratoplasty following removal of a posterior chamber intraocular lens (IOL), anterior vitrectomy, capsulectomy, and iris biopsy. Histopathologic examination revealed a pigmented iris nevus and signs of iris erosion by the IOL loop. Because 3 months later the eye developed streptococcal endophthalmitis and had to be eviscerated, we had the opportunity to examine the eye contents; we found no evidence of phakoanaphylactic uveitis.     

Argon laser iridotomy in primary angle-closure or pupillary block glaucoma

This paper describes the use of a pulsed argon laser to perform iridotomies in 87 patients. Diagnoses include: primary angle closure glaucoma, narrow angle in the fellow eye of patients with primary angle closure glaucoma, pupillary block, and after incomplete surgical iridectomies. Laser iridotomy was achieved in 79% of patients. Blue eyes were slightly more difficult to penetrate. Success was almost 100% in those with pupillary block. Penetration was most difficult in patients with primary angle closure glaucoma (64%), but more easily accomplished in the fellow eyes of such cases (87%). In 13 patients surgical peripheral iridectomy was performed on one eye while the other eye was treated with laser iridotomy. No apparent significant long term differences were noted between the two eyes of the same individual. Complications of laser iridotomy include corneal burns, pupil distortion, synechia formation, lenticular opacities, iritis, marked pigment dispersion, sudden rise in intraocular pressure, and retinal burns. At this time a longer follow-up is required before it can be stated that a laser PI is more advantageous than a surgical PI. However, the laser's simplicity and ease of administration appear to warrant its continued use at this time.     

Anterior approach to the sciatic nerve block: adaptation to the patient's height

To improve the incidence of block of the posterior femoral cutaneous nerve (PFCN) when using an anterior approach as described recently, we hypothesized that the distance between the inguinal line and the puncture site depends on the patient's height. A preliminary radiological study performed in 13 patients established a formula describing the relationships between the patient's height and the puncture site "S." A line was drawn between the anterior iliac spine and the superior angle of the pubic tubercle (inguinal line) and another line from the midpoint of the inguinal line to the puncture site "S." "S" was calculated from the midpoint of the inguinal line as "S" = (height in cm--100)/10. A prospective study was conducted in 53 patients. Results are presented as median (range, 0.25-0.75). Two minutes were required to locate the sciatic nerve at a depth of 12 cm (10.5-13.0 cm). Complete sciatic and PFCN blocks were observed in 92% of the patients. We conclude that consideration should be given to the patient's height when the sciatic nerve is blocked using an anterior approach. This technique seems to improve the success of block of the PFCN, essential to tolerate a thigh tourniquet. IMPLICATIONS: This prospective but noncomparative work was performed to evaluate a new anterior technique of sciatic block, an adaptation of the anatomic landmarks described by Chelly and Delaunay, to patient height.     

Anterior eyewall perforation during subconjunctival cataract block

A patient was given a new type of subconjunctival block in preparation for cataract surgery. During the insertion of the needle subconjunctivally, the anterior eyewall was inadvertently perforated, resulting in a tiny retinal tear and focal retinal detachment. The cataract surgery, including intraocular lens implantation, was carried out without further problems. The retinal tear and tiny detachment were repaired the next day by argon laser photocoagulation. The visual result was excellent. To our knowledge, this is the first report of anterior eyewall perforation occurring with the use of this new subconjunctival anesthetic block.     

Anterior approach to the sciatic nerve block: the effects of leg rotation

In the anterior approach to the sciatic nerve block, the femur often obstructs the passage of the needle toward the sciatic nerve. In this study, by using a human cadaver model, we assessed how internal and external rotation of the leg influences the accessibility of the sciatic nerve with the anterior approach. Ten lower extremities from five adult cadavers were studied. Needles were used to simulate the anterior approach to the sciatic nerve block. The effect of leg rotation on the needle plane required to reach the sciatic nerve was studied with legs in the neutral position and then with internal and external rotation (45 degrees) of the legs. During needle placement in the neutral position, the needle could not be fully advanced to the level of the sciatic nerve because of obstruction by the lesser trochanter in 80% of attempts. Medial redirection of the needle (10 degrees--15 degrees) allowed it to pass the lesser trochanter but brought the tip of the needle too medial to the sciatic nerve. Internal rotation of the leg facilitated passage of all needles inserted at the level of the lesser trochanter. We conclude that internal rotation of the leg may significantly facilitate needle insertion in the anterior approach to sciatic block.     

星状神经节阻滞对红细胞免疫粘附功能的影响

目的：观察了星状神经节阻滞对红细胞免疫粘附功能的影响。方法：选择适应症患者３３例，进行单侧星状神经节阻滞，每日１次，双侧交替，共７天。并于阻滞前、阻滞后３０分钟及阻滞７天后取外周血测定红细胞－Ｃ３ｂ受体花环率、红细胞－免疫复合物花环率和血清皮质醇的含量。结果：红细胞－Ｃ３ｂ受体花环率在阻滞后３０分钟有明显升高，阻滞７天后仍明显高于阻滞前水平（Ｐ＜０．０５）；红细胞－免疫复合物花环率在阻滞后有下降趋势，但与阻滞前比较无显著性差异（Ｐ＞０．０５）。血清皮质醇在阻滞后３０分钟有非常显著性降低，阻滞７天后仍明显低于阻滞前水平（Ｐ＜０．０１）。红细胞－Ｃ３ｂ受体花环率和血清皮质醇含量的相关分析显示，两者呈反向变化，但不存在直线相关关系。结论：７天连续星状神经节阻滞能提高红细胞免疫粘附功能，可能是通过对下丘脑－垂体－肾上腺轴的影响而发挥调节作用，但并非唯一机制。     

Anterior bone block: treatment of calcaneus deformity after failed soft-tissue operations

Calcaneus deformity is almost always the result of a neural disorder. It is progressive, disabling, and resistant to bracing and usually requires surgery. In immature feet, soft-tissue operations are the procedures of choice but have the disadvantage of recurrence due to stretching of soft tissues. However, bony operations will lead to growth center damage. Anterior bone block corrects the deformity without damaging the growth centers.     

Paravertebral block in the management of liver capsule pain after blunt trauma

We present a case of liver capsule pain after blunt abdominal trauma. The patient was unable to tolerate patient-controlled i.v. opioids, and epidural infusion of local anaesthetic was considered undesirable because of the potential risk of complications. Pain was managed successfully with paravertebral infusion of local anaesthetic at the right T10 level. Innervation of the liver and possible mechanisms of visceral pain processing are discussed.      

肾囊阻滞对大鼠胃肌电活动与胃动力的影响

目的:探讨肾囊阻滞对胃肌电活动与胃动力的影响,为用该法治疗胃肠动力紊乱性疾病提供理论依据。方法:将36只雄性SD大鼠随机均分为3组,分别腹腔注射阿托品、新斯的明、生理盐水制作胃肠运动抑制模型(抑制组)、胃肠运动亢进模型(亢进组)、正常对照模型(对照组),各组大鼠造模后均以肾囊注射利多卡因行肾囊阻滞处理。检测各组大鼠胃电信号与胃残留率并比较。结果:造模后,与对照组比较,抑制组胃电平均峰峰值与平均周期均明显降低,胃残留率明显增加,而亢进组各项指标变化正好相反(均P0.05)。肾囊阻滞前比较,肾囊阻滞后,对照组各项指标无明显改变(均P0.05);抑制组胃电平均峰峰值与平均周期均较肾囊阻滞前明显升高,而胃残留率明显减少(均P0.05);亢进组胃电平均峰峰值与平均周期均较肾囊阻滞前明显降低,而胃残留率明显增加(均P0.05)。结论:肾囊阻滞对正常胃电活动与运动功能无明显影响,但对异常胃电活动与运动功能则有双向调整作用。     

Anterior segment ischemia and sector iris atrophy: after strabismus surgery in a patient with chronic lymphocytic leukemia.

A 69-year-old woman with chronic lymphocytic leukemia developed segmental iris atrophy and iridocyclitis after routine surgery for exotropia. Both the clinical picture and fluorescein angiogram indicated anterior segment ischemia. It is postulated that this was related to hyperviscosity of the blood caused by a high white blood cell count (114,000/cu mm). The possibility of anterior segment ischemia should be kept in mind when contemplating strabismus or retinal detachment surgery in the presence of hematologic disorders likely to increase blood viscosity. In these cases a minimal amount of surgery should be done with proper supportive therapy. Strabismus surgery should be done in stages allowing for hemodynamic compensation between procedures.     

Staphylococcal adherence to chicken cartilage

Immature chicken cartilage was incubated in a Staphylococcus aureus suspension and then washed. Scanning electron microscopy and radiolabel measurements showed increased adherence to cartilage with increasing bacterial concentration. Preheating of the bacteria did not reduce the adherence property, but trypsin treatment did.