Intraocular lens implantation in traumatic cataract in children

Thirty-six cases of intraocular lens implantation in children who had cataracts of traumatic origin are presented. Shearing lenses were preferred for implantation in some of these cases. Our results generally support intraocular lens implantation in children whose cataracts are traumatically induced.     

Thrombolytic therapy for traumatic unilateral renal artery thrombosis

We report a case of traumatic unilateral renal artery thrombosis that was successfully treated by thrombolytic therapy. The patient was a 17-year-old woman, who had put her left upper abdomen between a wall and the handle of a ground roller when using it. A computed tomography scan with intravenous contrast showed a lack of contrast in the left kidney. Angiography showed complete occlusion of the left renal artery, and the diagnosis was traumatic left renal artery thrombosis. Following angiography, thrombolytic therapy was performed. Urokinase was administered into the left renal artery, and 360,000 units per 1.5 h was required. Thrombus disappeared and flow of left renal artery was observed. Recovery of left renal function was seen on renoscintigraphy. Surgical maneuvers for traumatic renal artery thrombosis are autotransplantation or thrombectomy generally, but we think that thrombolytic therapy following angiography is a less invasive method and saves warm ischemic time.     

Visual outcome after fireworks injuries

BACKGROUND: The epidemiology and prognosis of fireworks-related injuries treated at a tertiary eye care center in less developed nations remain unknown. METHODS: We conducted a prospective observational study that enrolled all consecutive eyes with fireworks-related ocular injury visiting our trauma clinic during a 1-year period. Eyes were graded by ocular trauma classification and followed for 6 months at least. Best corrected visual acuity (BCVA) at 6 months was considered the final visual outcome. Data were analyzed. RESULTS: Twenty-five (96%) of a total of 26 patients enrolled during study period were male patients and 13 (50%) were younger than 15 years. The type of fireworks involved was a bottle rocket in 38.5%. Factors significantly associated with better final visual outcome were better BCVA at presentation (p = 0.041), absence of bottle rocket injury (p = 0.028), closed globe injury (p = 0.028), absence of relative afferent pupillary defect (p = 0.019), absence of intraocular foreign body (p = 0.026), and absence of endophthalmitis (p = 0.006). Besides poor visual outcome, bottle rocket injuries were more frequently associated with facial lacerations, intraocular foreign body, and endophthalmitis development. CONCLUSION: Fireworks-related ocular injuries commonly affect young male subjects of northern India. Visual outcome is better in eyes having better initial BCVA or closed globe injury and if relative afferent pupillary defect, bottle rocket injury, intraocular foreign body, and endophthalmitis are absent.     

Mobility outcome following unilateral lower limb amputation

This study investigated mobility outcome following unilateral trans-tibial or trans-femoral amputation. It was an observational study at the sub-regional amputee rehabilitation centre in Sheffield, UK. All unilateral trans-tibial or transfemoral amputees referred during the study period were included. The Harold Wood Stanmore mobility grade was recorded approximately one year following initial assessment at the centre. Of the 357 amputees referred, complete outcome data was available for 281 (78.7%). The mean age was 68 years (range 16-95), 70.1% were male, and the aetiology of the amputation was vascular or diabetic in 87.5% of cases. Trans-tibial amputations accounted for 50.5% and trans-femoral 49.5%. Almost all trans-tibial and trans-femoral amputees aged 50 and under achieved functional household and community mobility. Approximately 50% of the trans-tibial amputees aged over 50 years gained independent community mobility and around 60% household mobility. There was a significant worsening of community mobility rates with increasing age but for household mobility the differences did not reach statistical significance. Fewer than 25% of trans-femoral amputees aged over 50 achieved community mobility and around 50% achieved household mobility. There was a statistically significant deterioration in both community and household mobility levels with increasing age. This study concludes that mobility rates one year after prosthetic provision for unilateral trans-tibial and trans-femoral amputees worsen with increasing age at amputation and a higher level of amputation.     

Course and outcome of severe traumatic coma

This study will consider the course and final outcome of severe traumatic coma (Glasgow coma scale score 5-3 at admission). Intensive rehabilitation programs aimed at functional recovery must be undertaken from the very beginning. The importance of retraining of axial motricity is stressed. Successive stages of evolution and various neurological syndromes disclosed during the awakening period are described. Even in the case of these very severe brain injuries, a considerable amount of recovery is possible and leads to a normal socio-economic status in 62% of the cases. 22% however will remain bound to some type of sheltered life. Functional outcome is not related to the depth of initial coma but rather to the length of comatose period. It can be safely predicted only at the awakening phase, the neurological status reached at this time reflecting rather well the overall extent and severity of brain lesions. Neurophysiological mechanisms likely to support the functional recovery after this type of trauma are discussed.     

Management and outcome of traumatic aortic injuries

BACKGROUND AND AIMS: Aortic injuries are rare and associated with high early mortality challenging the surgical services both from a technical as well as organisational point of view, especially in countries with low incidence of trauma. A Finnish experience in the management of aortic injuries is reported with special emphasis on outcome after early involvement of cardiothoracic surgeons. MATERIAL AND METHODS: Retrospective analysis of hospital records identified 36 consecutive patients with aortic injuries arriving alive to the hospital during a 32-year period of 1967-98. RESULTS: Of the 19 thoracic aortic injuries, 17 (89%) were caused by blunt trauma, 8 (42%) of the patients arrived in shock, 7 (37%) died before repair could be attempted, 11 (58%) underwent repair with prosthesis and one (5%) with sutures, with an overall mortality rate of 9/19 (47%). Of the 17 patients with abdominal aortic injuries (15 penetrating), 13 (76%) arrived in shock, 3 (18%) died before repair, 13 (76%) were repaired with sutures and one (6%) with prosthesis, with an overall mortality rate of 8/17 (47%). Fourteen (82%) of the 17 non-survivors died within 24 hours from the injury, 13 from exsanguination and one from associated brain injury. CONCLUSIONS: Abdominal aortic injuries are usually penetrating, diagnosed intraoperatively and amenable to suture repair with good results indicating that stable and unstable patients with potential aortic injuries after penetrating abdominal trauma can safely be managed in hospitals with experienced general surgeons on call. In contrast, stable patients with suspected thoracic aortic injuries could benefit from early transfer to a hospital with cardiothoracic surgical facilities and personnel.     

Characteristics of pediatric traumatic cataract and factors affecting visual outcomes

PurposeTo evaluate the clinical characteristics, surgical approach and visual results in pediatric traumatic cataract.Material and methodsData of pediatric and adult traumatic cataract patients were retrospectively analyzed. Age, gender, cause and zone of trauma, additional clinical findings, initial and final visual acuity (VA) were analyzed and compared between groups.ResultsThe mean age of 18 patients in the pediatric group was 9.4(SD 5.7); 18 patients in the adult group was 47.8(16.2) years. There was a male predominance in both groups (12/16 male, respectively). The most common cause of trauma was sharp metal objects (50%) in the pediatric group and wooden and traffic accidents (33%) in the adult group. The initial mean VA of the patients were 0.03(0.09), 0.09(0.1) in the pediatric and adult groups, respectively, (p: 0.34). The mean ocular trauma score (OTS) was 51.4(16.4) and 59.6(10.5) in the pediatric and adult groups, respectively (p: 0.09). Simultaneous surgery was performed in 5 (28%) eyes in both groups. Subsequent lens extraction and IOL implantation were performed in 10 of pediatric and 13 of adult patients. The final VA was 0.3(0.7), 0.3(0.4) in the pediatric and adult group, respectively (p: 0.94). Final VA was correlated with OTS in both of the groups and the presence of additional surgery in the pediatric group.ConclusionTraumatic cataract is a major cause of visual loss in children. Lower OTS and presence of additional surgery were the prognostic factors for poor final VA in the pediatric cases. Optimal timing and accurate management of traumatic cataract are important in the pediatric population.     

Visual electrodiagnostic findings in mild traumatic brain injury

Patients with traumatic brain injury TBI frequently exhibit varied forms of visual system dysfunction including: binocular, oculomotor, accommodative, refractive error shift, visual field loss, and visual perceptual deficits. A 5-year collaborative study between optometry and ophthalmology was initiated to follow documented mild TBI patients utilizing diagnostic methods to assess the quantity and quality of visual system deficits and recovery. A group of patients with mild TBI receiving optometric rehabilitation were compared with a group of age-matched, gender-matched, and headsize-matched TBI patients not receiving such treatment. Eighteen patients diagnosed with mild TBI underwent a treatment regimen of optometric rehabilitation group I ; 32 patients diagnosed with mild TBI did not receive optometric rehabilitation group II . Pattern visually evoked cortical potential VECP testing and electroretinography ERG evaluation were utilized initially, repeated 6-12 months later and then 12-18 months after baseline. All TBI patients' VECP and ERG results were compared to agematched, headsize-matched controls. Once the ERG had been used to exclude retinal involvement, identification of visual pathway dysfunction was possible with the VECP. Full-field ERG results in all groups were not remarkable and not sensitive for patients with mild TBI. Initial testing results revealed that 72 of those TBI patients in group I demonstrated VECP waveform abnormalities and 81 of those patients in group II showed waveform dysfunction. In the testing performed 12-18 months later, 38 of group I TBI patients, after receiving a treatment regimen of optometric rehabilitation, showed VECP waveform abnormalities; 78 of group II TBI patients demonstrated waveform abnormalities. VECP evaluation in patients with mild TBI can provide a useful and reliable tool for objective assessment of visual system deficit and recovery. Significant differences in visual system recovery were shown when comparing group I and group II.     

Psychiatric treatment outcome following traumatic brain injury

The relationship between self-reported history of traumatic brain injury (TBI) and psychiatric treatment outcome was investigated. TBI was hypothesized to be frequent, associated with cognitive deficits on neuropsychological testing, and less amenable to standard psychiatric treatment. Subjects were 42 psychiatric patients with a self-reported history of TBI and 25 psychiatricpatients with no TBI history. Subjects received approximately 2 weeks of inpatient psychiatric treatment. Subjects received neuropsychological testing and completed the Brief Symptom Inventory weekly. TBI was frequent (66% of subjects); multiple injuries were common. Neuropsychological performance was generally average in both groups with few group differences. Subjects, on average, reported significantly decreased psychiatric symtoms on discharge. However, the TBI group appeared to improve less than the control group; group status was a significant predictor of treatment outcome. Implications of results for assessment and treatment of psychiatric disorders in patients with a history of TBI are discussed.     

Neuropsychological outcome after traumatic temporal lobe damage

Summary The most frequent sequelae after severe brain injury include changes in personality traits, disturbances of emotional behaviour and impairment of cognitive functions. In particular, emotional changes and/or verbal and non verbal dysfunctions were found in patients with bilateral or unilateral temporal lobe lesions. The aim of our study is to correlate the localization of the brain damage after severe brain injury, in particular of the temporal lobe, with the cognitive impairment and the emotional and behavioural changes resulting from these lesions.The patients with right temporal lobe lesions showed significantly better scores in verbal intelligence and verbal memory in comparison with patients with left temporal lobe lesions and those with other focal brain lesions or diffuse brain damage. In contradistinction, study of the personality and the emotional changes (MMPI and FAF) failed to demonstrate pathological scores in the 3 groups with different CT lesions, without any significant difference being found between the groups with temporal lesions and those with other focal brain lesions or diffuse brain damage.The severity of the brain injury and the prolongation of the disturbance of consciousness could, in our patients, account for prevalence of congnitive impairment on personality and emotional changes.     

Intraocular lens implantation in unilateral congenital cataract: A preliminary report

We performed pars plana lensectomy with secondary anterior chamber intraocular lens (IOL) implantation in 32 cases of unilateral congenital cataract with otherwise normal appearing eyes. Five of the 12 patients old enough to respond achieved a visual acuity of 20/60 or better with evidence of fusion. We advocate operating within the first few months of life to lessen amblyopia.     

Functional outcome following traumatic spondylolisthesis of the axis

We reviewed 36 consecutive patients, 24 males and 12 females, presenting to our institution, a tertiary referral spinal trauma centre, over a 6-year period. The mean age was 46 (range18–82 years) years. We assessed: (a) the mechanism of injury, (b) the mode of treatment, (c) the radiographic classification using the Levine and Edwards system and (d) functional outcome using the cervical spine outcomes questionnaire (CSOQ) by BenDebba. The commonest mechanism of injury was road traffic accidents. There were 14 Type-I, 11 Type-II and 1 Type-IIA fractures. Twenty-seven patients were treated with halo-vest immobilisation and nine were immobilised in a Minerva jacket. All fractures demonstrated radiographic union at a mean of 12 (range 10–16) weeks. There were no neurological complications. Upon review, all patients, whether Type-I or Type-II demonstrated low CSOQ scores approaching their pre-morbid status. However, Type-II fractures scored higher in three functional outcome categories when compared to Type-I fractures.     

Ultrasonographic evaluation of the ankle after unilateral traumatic lower limb amputations

Background

Unilateral lower limb amputation can alter the tissue morphology leading to increase future risk of degenerative secondary disorders.

Psychosocial outcome risk indicator: predicting psychosocial outcome following traumatic brain injury

This study examines the outcome of 29 individuals with traumatic brain injury (TBI) and 23 of their respective significant others, 12 months after discharge from inpatient rehabilitation services, as a means of determining the validity of a measure developed to predict psychosocial outcome. This measure consists of 18 questions that examine 12 factors and requires the rater to make a judgement about the likely impact each factor would have on the individual with TBI and significant other. Results indicate that the social work raters accurately predicted outcome according to the factors contained in the measure. Scores on the measure at discharge were also found to be associated with general psychological distress, anxiety and insomnia, depression, family functioning, and the problems related to emotion and behaviour. Although the sample size was small, there is an indication that the devised measure is useful in predicting outcome and so has clinical value in identifying adults at greatest risk of poor psychosocial outcome after a traumatic brain injury.     

Visual results after cataract surgery by a military resident surgeon

We compare the visual results of cataract surgery performed by a military resident with those achieved by civilian surgeons. Upon reviewing the first 47 extracapsular cataract extractions performed by one resident military surgeon, we found that 98% of eyes achieved a final visual acuity of 20/40 or better, and 95% were 20/25 or better. The mean surgically induced astigmatism was 0.54 diopters, with 97% less than or equal to 2 D from preoperative values. Eighty-three percent of eyes receiving intraocular lenses were within 2 D of emmetropia. The mean residual refractive error in those eyes was +0.121. Complications were infrequent (17%). These results compare favorably with other reports.