Science.gov

Sample records for accidental macular injury

  1. Macular hole surgery following accidental laser injury with a military rangefinder

    NASA Astrophysics Data System (ADS)

    Custis, Peter H.; Gagliano, Donald A.; Zwick, Harry; Schuschereba, Steven T.; Regillo, Carl D.

    1996-04-01

    An active duty marine corps service member had bilateral full thickness macular holes induced following accidental Q-switched laser exposure from a hand held Neodymium range finder (ANGVS-5). The right eye had a large hole nasal to the fovea, while the left eye had a much smaller hole closer to the fovea centralis. Over the 18 months following the injury, the left eye demonstrated mild progressive degradation in visual function, but retained 20/20 final visual acuity. In contrast, the hole in the right eye increased in size, developed a localized retinal detachment with cystic changes in the fovea, and had atrophy of the retinal pigment epithelium. Within 6 months after injury, acuity declined to 20/100. Macular hole surgery was performed with a goal of sealing the edges of the hole in order to allow resolution of the localized detachment and cystic changes in the fovea. In spite of surgical techniques that are generally successful in the treatment of macular holes associated with other etiologies, the fundus findings remained unchanged and visual acuity declined to 20/400. To the best of our knowledge, this is the first case report of macular hole surgery for this condition.

  2. Accidental macular hole following neodymium:YAG posterior capsulotomy.

    PubMed

    Munteanu, Mihnea; Petrović, Zarko; Stanca, Horia; Rosca, Cosmin; Jianu, Adelina; Boruga, Ovidiu

    2014-01-01

    Posterior capsular opacification (PCO) is the commonest complication of cataract surgery, occurring in up to one-third of patients in a period of five years. The treatment of choice is the Neodymium:YAG laser posterior capsulotomy. This treatment can be associated with several complications, some of them severe. A rare complication of this procedure is the accidental induced macular hole. A 54-year-old female patient was referred to our Department because of a severe loss of vision and a central scotoma at the right eye. The patient underwent a Nd:YAG posterior capsulotomy 2 days ago, for a PCO. The fundus examination at presentation revealed a round retinal defect in the macular region, a massive inferior preretinal hemorrhage and a mild vitreous hamorrhage. A 6-months follow-up of the case, including retinography and fluorescein angiography, is presented. Although the Nd:YAG laser capsulotomy is a safe, noninvasive, and effective outpatient procedure to improve vision hindered by PCO, it must be recognized that it carries a low but definite risk of serious complications. Physicians and patients should be aware of these rare but severe complications regarding this otherwise safe procedure. Fortunately, most of the complications related to this procedure are transient and can be managed by proper medication.

  3. Bilateral macular injury caused by a femtosecond laser.

    PubMed

    de Juan-Marcos, L; Cañete-Campos, C; Cruz-González, F; López-Corral, A; Hernández-Galilea, E

    2014-11-01

    We describe the case of a 35-year-old man who arrived in the Emergency Department with bilateral macular injury caused by accidental exposure to an industrial femtosecond laser. Workers operating industrial lasers must protect their eyes properly when handling these devices. Otherwise, retina damage may occur which usually is recoverable. However, sometimes this damage causes permanent visual loss. Copyright © 2011 Sociedad Española de Oftalmología. Published by Elsevier Espana. All rights reserved.

  4. Clinical clues for head injuries amongst Malaysian infants: accidental or non-accidental?

    PubMed

    Thalayasingam, M; Veerakumarasivam, A; Kulanthayan, S; Khairuddin, F; Cheah, I G S

    2012-12-01

    Identifying the differences between infants with non-accidental head injuries (NAHI) and accidental head injuries (AHI) may help alert clinicians to recognize markers of abuse. A retrospective review of infants <1 year of age admitted to a tertiary referral centre in Malaysia over a two year period with a diagnosis of head injury or abnormal computed tomography head scans was conducted to identify the clinical features pointing towards a diagnosis of NAHI by comparing the socio-demographics, presenting complaints, clinical features and the extent of hospital investigations carried out. NAHI infants were more likely to be symptomatic, under a non-related caregiver's supervision, and presented with inconsistent or no known mechanism of injury. Subdural haemorrhages were more common in NAHI infants. The history, mechanism of injury, presenting signs and symptoms as well as the nature of the injuries sustained are all valuable clues as to whether a head injury sustained during infancy is likely to be accidental or not. Copyright © 2012 Elsevier Ltd. All rights reserved.

  5. Thermal macular injury from a 154 mW green laser pointer.

    PubMed

    Lim, Maria E; Suelzer, Joseph; Moorthy, Ramana S; Vemuri, Gautam

    2014-12-01

    We report a case of accidental thermal injury due to improper use of a laser pointer obtained outside of the United States. A 13-year-old received a laser pointer as a gift and looked at a reflection of the beam. The patient underwent full ophthalmologic examination with fundus photography, spectral domain optical coherence tomography, and fluorescein angiography. Visual acuity in the left eye was 20/100 at presentation. Fundus examination and ancillary tests were consistent with thermal macular injury. The laser pointer was analyzed and found to be a green diode laser with average power output of 154 mW.

  6. 76 FR 58566 - Proposed Information Collection (Report of Accidental Injury in Support of Claim for Compensation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-21

    ... techniques or the use of other forms of information technology. Title: Report of Accidental Injury in Support... AFFAIRS Proposed Information Collection (Report of Accidental Injury in Support of Claim for Compensation... needed to support a claim for disability benefits based on an accidental injury. DATES: Written comments...

  7. Bilateral macular injury from a green laser pointer.

    PubMed

    Dirani, Ali; Chelala, Elias; Fadlallah, Ali; Antonios, Rafic; Cherfan, George

    2013-01-01

    We report the case of a 13-year-old boy who had a bilateral macular injury after playing with a green laser pointer for a duration of 1 minute. Clinical examination revealed a decrease in visual acuity and macular injury in both eyes, and imaging investigations revealed a bilateral macular lesion due to exposure to the laser pointer. At 3 months' follow up, visual function had improved but remained partially impaired. This case emphasizes the importance of cautious and appropriate use of laser pointer devices because of the potential vision-threatening hazards induced by mishandling of these devices.

  8. Accidental injury: risk and preventative interventions

    PubMed Central

    van Weeghel, I.; Kendrick, D.; Marsh, P.

    1997-01-01

    Accepted 16 April 1997
 OBJECTIVE—To evaluate the relation between risk factors for childhood unintentional injury and requests for injury prevention interventions as part of the Nottingham Safe at Home project, a primary care based controlled intervention study assessing the effectiveness of a package of injury prevention interventions.
SETTING—17 practices in Nottingham randomly selected from 55 practices volunteering to take part in the study.
METHODS—Postal questionnaire to all parents of children aged 3 to 12 months registered with the intervention practices (n = 1124) to assess risk factors for injury and to elicit requests for three injury prevention interventions: free home safety checks, low cost safety equipment, and free first aid training.
RESULTS—73% of parents responded to the questionnaire. The distribution of sociodemographic variables among responders was similar to that for the population of Nottingham. One third of parents (34%) requested one intervention, 21% requested two interventions, and 10% requested three. Receipt of means tested benefits, ethnicity, and residence in a deprived area were independently associated with requesting home safety checks. Non-owner occupation, lack of access to a car, receipt of means tested benefits, ethnicity, and unemployment were independently associated with requesting low cost safety equipment. Non-owner occupiers were less likely to request first aid training.
CONCLUSIONS—Families with risk factors for childhood unintentional injury do request home safety checks and low cost safety equipment, but they are less likely to request first aid training. Other methods for providing first aid advice may be needed to reach such families.

 PMID:9279147

  9. Accidental Laser Injury to the Eye.

    PubMed

    Kandari, Jamal Al; Raizada, Seemant; Razzak, Ahmed Abdul

    2010-03-09

    The unprotected human eye is extremely sensitive to laser radiation and can be permanently damaged from direct or reflected beams. Two cases of retinal injury by laser exposure outside hospital setting are reported. Two patients presented in retina clinic in Al-Bahar eye center in Kuwait with complaints of decrease in vision following exposure to unknown light. Case 1 was exposed to a laser used in military warfare and Case 2 exposed to laser pointer. Routine slit lamp examination and fundus examination of the patient was done along with fundus fluorescien angiography (FFA) and Optical coherence tomography (OCT). Patients were followed up in out patient department for 6 months. Patient with military laser exposure had severe permanent vision loss and persisted even after 6 months. Patient exposed to laser pointer beam had transient visual loss, which improved to 20/25 at 7 months follow-up. Laser retinal damage should be suspected in any patient with visual complaints after obvious exposure to unknown strong light. The treatment for laser retinal injuries is extremely limited and hence prevention is essential.

  10. Apnoea and brain swelling in non-accidental head injury

    PubMed Central

    Kemp, A; Stoodley, N; Cobley, C; Coles, L; Kemp, K; Geddes, J

    2003-01-01

    Aims: (1) To identify whether infants and young children admitted to hospital with subdural haematomas (SDH) secondary to non-accidental head injury (NAHI), suffer from apnoea leading to radiological evidence of hypoxic ischaemic brain damage, and whether this is related to a poor prognosis; and (2) to determine what degree of trauma is associated with NAHI. Methods: Retrospective case series (1992–98) with case control analysis of 65 children under 2 years old, with an SDH secondary to NAHI. Outcome measures were presenting symptoms, associated injuries and apnoea at presentation, brain swelling or hypoxic ischaemic changes on neuroimaging, and clinical outcome (KOSCHI). Results: Twenty two children had a history of apnoea at presentation to hospital. Apnoea was significantly associated with hypoxic ischaemic brain damage. Severe symptoms at presentation, apnoea, and diffuse brain swelling/hypoxic ischaemic damage were significantly associated with a poor prognosis. Eighty five per cent of cases had associated injuries consistent with a diagnosis of non-accidental injury. Conclusions: Coma at presentation, apnoea, and diffuse brain swelling or hypoxic ischaemia all predict a poor outcome in an infant who has suffered from SDH after NAHI. There is evidence of associated violence in the majority of infants with NAHI. At this point in time we do not know the minimum forces necessary to cause NAHI. It is clear however that it is never acceptable to shake a baby. PMID:12765909

  11. 76 FR 73021 - Agency Information Collection (Report of Accidental Injury in Support of Claim for Compensation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-28

    ... Injury in Support of Claim for Compensation or Pension/Statement of Witness to Accident, VA Form 21- 4176...: VA Form 21-4176 is used to support a claim for disability benefits based on an accidental injury that... AFFAIRS Agency Information Collection (Report of Accidental Injury in Support of Claim for Compensation or...

  12. Clinical perspectives on osteogenesis imperfecta versus non-accidental injury.

    PubMed

    Pereira, Elaine Maria

    2015-12-01

    Although non-accidental injuries (NAI) are more common in cases of unexplained fractures than rare disorders such as osteogenesis imperfecta (OI), ruling out OI and other medical causes of fracture is always indicated. The majority of OI patients can be diagnosed with the help of family history, physical examination, and radiographic findings. In particular, there are a few radiological findings which are seen more commonly in NAI than in OI which may help guide clinician considerations regarding the probability of either of these diagnoses. At the same time, molecular testing still merits careful consideration in cases with unexplained fractures without obvious additional signs of abuse. © 2015 Wiley Periodicals, Inc.

  13. Accidental low velocity atypical missile injury to the head.

    PubMed

    Chattopadhyay, Saurabh

    2008-12-01

    Missile injuries on the head are mostly due to firearms. Atypical missiles may be encountered in case of shrapnel of bomb explosions but rarely because of stones. The present case is a rare case where a stone propelled by the pressure from the rear wheel of a speeding truck on the highway, struck the head of a 7-year-old girl resulting in fatality. Reconstruction of the incident on the basis of history and postmortem findings throws some light on the mechanism. The case is unique as it is the first reported case of an accidental missile injury to the head resulting in fatality without any direct human involvement for propulsion of the projectile.

  14. Delayed upper-airway injury after accidental alkaline ingestion.

    PubMed

    Ryan, Matthew F; Fernandez, Mindy; Laauwe, Karen

    2014-01-01

    A 62-year-old man presented to the emergency department one week after accidentally drinking an alkaline cleaning agent stored in unlabeled bottle. The day of the incident the patient presented to an outside hospital where he was admitted for an upper endoscopy of the esophagus which was found to be negative for acute injury. An initial chest X-ray taken the day of the incident was also found to be normal. After discharge the patient continued to have a sore throat and marked dysphagia which caused him to vomit repeatedly. Moreover, the patient began to develop chest pain with associated shortness of breath. We present a case of delayed airway injury and tracheal thickening and associated chest pain after alkaline ingestion and we discuss herein the pathophysiology and management of alkaline ingestions.

  15. Delayed Upper-Airway Injury after Accidental Alkaline Ingestion

    PubMed Central

    Ryan, Matthew F.

    2014-01-01

    A 62-year-old man presented to the emergency department one week after accidentally drinking an alkaline cleaning agent stored in unlabeled bottle. The day of the incident the patient presented to an outside hospital where he was admitted for an upper endoscopy of the esophagus which was found to be negative for acute injury. An initial chest X-ray taken the day of the incident was also found to be normal. After discharge the patient continued to have a sore throat and marked dysphagia which caused him to vomit repeatedly. Moreover, the patient began to develop chest pain with associated shortness of breath. We present a case of delayed airway injury and tracheal thickening and associated chest pain after alkaline ingestion and we discuss herein the pathophysiology and management of alkaline ingestions. PMID:25013732

  16. Accidental Bolt Gun Injury to Femur - A Case Report

    PubMed Central

    Kattimani, Ravi Prasad; Shetty, Sanath; Mirza, Humayun

    2016-01-01

    Introduction: Bolt gun or slaughterer’s guns are used in meat industry for “humane killing” of animals. Injuries caused by bolt gun are rare, reported exclusively from central European countries. We report a case of 28 year old male, who accidentally shot himself with a bolt gun to his right thigh. Case Report: A 28 years old male presented to our Accident and Emergency department after accidental injury to his right thigh with bolt gun. He had an entry wound measuring 2 cm in length and 1 cm in breadth over anterior aspect of lower one third of thigh at lower and sustained Grade II compound fracture of right femur shaft at distal one third. The wound was treated with multiple debridements, negative pressure wound therapy and intravenous antibiotics based on culture and sensitivity. Conclusion: Bolt gun or slaughterer’s guns are weapons used in meat industry for slaughtering animals. Wounds inflicted by bolt guns have specific morphological feature, distinctive from wounds made by other kinds of hand firearms. Most of the time wound will be infected at presentation. Lesions caused by these weapons are likely to have a more serious character than is to be expected from the size of the entrance wound. The mainstay of treatment is liberal wound exploration, multiple debridement’s and intra venous antibiotics based on culture reports to treat infection and prevent morbidity. PMID:28164044

  17. Childhood death attributable to trauma: is there a difference between accidental and abusive fatal injuries?

    PubMed

    Ortega, Henry W; Vander Velden, Heidi; Kreykes, Nathaniel S; Reid, Samuel

    2013-09-01

    Trauma is a leading cause of death among children worldwide. Detailed knowledge of the epidemiology of childhood fatal injuries is necessary for preventing injuries. To determine clinical differences between children who were treated in an emergency department for accidental or abusive injuries. A retrospective review of all deceased patients who were treated in two urban pediatric emergency departments between 1998 and 2010 was performed. Patients were categorized into two groups, accidental and abusive, for comparison. A total of 1498 patients died during the study period, with 124 deaths being attributable to injury for a rate of 9.5 injury-related deaths per year. Most fatal injuries were accidental. Children with abusive fatal injuries were younger and more likely to have been seen for an injury in a clinic or emergency department within 2 months of their death. Eighty-two percent of abusive fatal injuries had documented subdural hematomas, whereas only 7.2% of accidental fatal injuries had a subdural hematoma documented. Nearly 50% of abusive fatal injuries had retinal hemorrhages reported, although no child with an accidental fatal injury had this type of injury documented. Younger children, especially those previously seen in an emergency department or clinic for injury, are more likely to sustain an abusive fatal injury. Sentinel physical findings associated with abusive fatal injuries include subdural hematomas and retinal hemorrhages, and the presence of these findings should prompt an investigation into the circumstances of injury. Copyright © 2013 Elsevier Inc. All rights reserved.

  18. Involving Parents in Indicated Early Intervention for Childhood PTSD Following Accidental Injury

    ERIC Educational Resources Information Center

    Cobham, Vanessa E.; March, Sonja; De Young, Alexandra; Leeson, Fiona; Nixon, Reginald; McDermott, Brett; Kenardy, Justin

    2012-01-01

    Accidental injuries represent the most common type of traumatic event to which a youth is likely to be exposed. While the majority of youth who experience an accidental injury will recover spontaneously, a significant proportion will go on to develop Post-Traumatic Stress Disorder (PTSD). And yet, there is little published treatment outcome…

  19. Involving Parents in Indicated Early Intervention for Childhood PTSD Following Accidental Injury

    ERIC Educational Resources Information Center

    Cobham, Vanessa E.; March, Sonja; De Young, Alexandra; Leeson, Fiona; Nixon, Reginald; McDermott, Brett; Kenardy, Justin

    2012-01-01

    Accidental injuries represent the most common type of traumatic event to which a youth is likely to be exposed. While the majority of youth who experience an accidental injury will recover spontaneously, a significant proportion will go on to develop Post-Traumatic Stress Disorder (PTSD). And yet, there is little published treatment outcome…

  20. Prevention and control of serious trauma and accidental injury in China: Timely but difficult.

    PubMed

    Fu, Xiaobing; Lu, Shuliang; Wang, Zhengguo

    2013-01-01

    Serious trauma and accidental injury are the leading causes of death among people younger than 45 years old in China. Thus, the prevention and control of serious trauma and accidental injury are important for reducing these deaths. The concept is timely but difficult. Here, we review the current state of serious trauma and accidents in China and other countries, focusing on road accidents, and provide our personal perspectives and suggestions on how to prevent and control these serious injuries in China.

  1. Youth versus adult "weightlifting" injuries presenting to United States emergency rooms: accidental versus nonaccidental injury mechanisms.

    PubMed

    Myer, Gregory D; Quatman, Carmen E; Khoury, Jane; Wall, Eric J; Hewett, Timothy E

    2009-10-01

    Resistance training has previously been purported to be unsafe and ineffective in children. The purpose of this investigation was to evaluate resistance training-related injuries presenting to U.S. emergency rooms by age, type, and mechanism of injury. We hypothesized that older athletes would sustain greater percentages of joint sprains and muscle strains, whereas younger athletes would sustain a greater percentage of accidental injuries that would result in an increased percentage of fractures in youths. The U.S. Consumer Product Safety Commission (CPSC) National Electronic Injury Surveillance System was queried from 2002 to 2005 using the CPSC code for "Weightlifting." Subjects between the ages of 8 and 30 were grouped by age categories 8 to 13 (elementary/middle school age), 14 to 18 (high school), 19 to 22 (college), and 23 to 30 (adult). Injuries were classified as "accidental" if caused by dropped weight or improper equipment use. Multiple logistic regression was used to compare accidental injuries between age groups. The sample consisted of 4,111 patients. Accidental injuries decreased (p < 0.05) with age: 8 to 13 > 14 to 18 > 19 to 22 years = 23 to 30 years. Conversely, sprain/strain injuries increased in each successive age group (p < 0.05). Evaluation of only the nonaccidental injuries (n = 2,565) showed that the oldest categories (19-22 and 23-30 yr) demonstrated a greater percentage of sprains and strains relative to younger age categories (p < 0.001). Two thirds of the injuries sustained in the 8 to 13 group were to the hand and foot and were most often related to "dropping" and "pinching" in the injury descriptions, and there was an increased percentage of fractures in the 8 to 13 group relative to all other groups (p < 0.001). The study findings indicate that children have lower risk of resistance training-related joint sprains and muscle strains than adults. The majority of youth resistance training injuries are the result of accidents that are

  2. Characterization and Comparison of Injuries Caused by Accidental and Non-accidental Blunt Force Trauma in Dogs and Cats.

    PubMed

    Intarapanich, Nida P; McCobb, Emily C; Reisman, Robert W; Rozanski, Elizabeth A; Intarapanich, Pichai P

    2016-07-01

    Motor vehicle accidents (MVA) are often difficult to distinguish from non-accidental injury (NAI). This retrospective case-control study compared animals with known MVA trauma against those with known NAI. Medical records of 426 dogs and cats treated after MVA and 50 after NAI were evaluated. Injuries significantly associated with MVA were pelvic fractures, pneumothorax, pulmonary contusion, abrasions, and degloving wounds. Injuries associated with NAI were fractures of the skull, teeth, vertebrae, and ribs, scleral hemorrhage, damage to claws, and evidence of older fractures. Odds ratios are reported for these injuries. MVA rib fractures were found to occur in clusters on one side of the body, with cranial ribs more likely to fracture, while NAI rib fractures were found to occur bilaterally with no cranial-caudal pattern. Establishing evidence-based patterns of injury may help clinicians differentiate causes of trauma and may aid in the documentation and prosecution of animal abuse. © 2016 American Academy of Forensic Sciences.

  3. Abnormal Sleep Duration Is Associated with a Higher Risk of Accidental Injury.

    PubMed

    Bhattacharyya, Neil

    2015-12-01

    Develop normative data for adult sleep duration and determine if nonstandard sleep time relates to the likelihood of accidental injury. Cross-sectional analysis. National health information database. The National Health Interview Survey, 2004-2013, was examined for adult sleep time and accidental injury within the past 3 months. The mean hours slept per night was determined. The relationship between sleep time and incidence of accidental injury was determined for any injury, injury while driving, and injury while working, adjusting for demographic variables. Among 221.4 million adults (raw sample, N = 282,692), the mean sleep time was 7.17 hours (95% confidence interval [95% CI], 7.16-7.18 hours). Men and women slept very similar times (7.14 vs 7.17 hours, respectively), and sleep time decreased until the fifth decade (minimum, 6.99 hours), increasing each decade thereafter; 2.81% of adults reported being accidentally injured in the preceding 3 months. Too little sleep and excessive sleep times were both associated with higher rates of accidental injury (odds ratio per hour of deviation from mean, 1.16 [95% CI, 1.12-1.19]), adjusting for age, sex, marital status, and education level. Similar increased odds ratios were noted for injury while driving (1.11 [95% CI, 1.01-1.22]) and injury while at work (1.12 [95% CI, 1.04-1.20]) with sleep time deviation. Most adults sleep between 7 and 8 hours nightly. Adults with sleep time outside this range, with either less or more sleep, have increased rates of accidental injury. These data highlight the need for sufficient quantity and quality of sleep in preventing accidental injury. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.

  4. Non-accidental head injury: a consequence of deprivation?

    PubMed

    Mok, J Y Q; Jones, P A; Myerscough, E; Shah, A R F; Minns, R A

    2010-12-01

    Non-accidental head injury (NAHI) is a significant personal and public health problem, with considerable mortality and morbidity. The evidence base for risk factors specific for NAHI is limited due to difficulties with case definition and study design. The risk factors associated with NAHI in infants was evaluated in this study, and the extent to which indices of deprivation influence this health problem was addressed. A 10-year prospective study was conducted in Scotland involving all paediatric hospitals and other general hospital departments admitting children. Subjects were children ≤2 years of age, with a diagnosis of "suspected NAHI". Socioeconomic characteristics of the index cases were compared to the general population, using the Scottish Index of Multiple Deprivation (SIMD) 2006. There were highly significant differences (p<0.001) between the SIMD rank scores of the NAHI cases and scores for the whole Scottish population. For the cohort, SIMD ranks ranged from 34 to 6253 (median 1210; mean 1577) compared to the population range of 1-6505 (median and mean=3253). Similar differences were found for each of the component domains of income, employment, health, education, crime and housing (p<0.001). In contrast, the scores for "geographic access" (to essential service) were higher than for the whole population (p<0.001), indicating that the deprivation was not due to lack of local services. In Scotland, children who present with suspected NAHI originate predominantly from the most deprived areas of the community. Public health and intervention strategies should be focused in these areas.

  5. Profile of non-accidental childhood injury at a tertiary hospital in south-west Nigeria.

    PubMed

    Olatunya, Oladele Simeon; Isinkaye, Ayodeji Olusola; Oluwadiya, Kehinde Sunday

    2015-06-01

    Injury threatens children lives worldwide. Most studies from Nigeria have been on accidental injuries in children. To study the profile of non-accidental injuries among children receiving care at a tertiary hospital in Nigeria. Children with non-accidental injuries were serially recruited and studied. The Paediatrics Trauma Score (PTS) was tested against the outcome. Non-accidental injuries accounted for 0.84% of all 5264 patients and 21.3% of the 207 injured. The case fatality rate was 6.8%. Physical abuse, sexual assault, drowning/near drowning, gunshot, poisoning and human bite caused the injuries in 68.2, 13.6, 6.8, 4.5, 4.5 and 2.3%, respectively. One-way analysis of variance and Tukey post hoc analysis showed that the mean PTS score of patients who died was significantly lower than the scores of those who were either discharged home or who discharged against medical advice (p < 0.001). The burden of non-accidental childhood injuries was high in the study area. © The Author [2015]. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  6. Epidemiological Characteristics and Overall Burden of Accidental Injuries in Navarra, Spain: Epidemiology of Injuries in Children.

    PubMed

    Ferraz-Torres, Marta; Belzunegui-Otano, Tomás; Martínez-García, Oscar; Iriarte-Cerdán, Laura; Salgado-Reguero, Esther

    2016-01-01

    Injuries caused by accidents or violent situations in pediatric patients are a serious social problem where prevention plays a key role. The aim of this study was to describe the epidemiological situation of pediatric injuries in Spain. A prospective study of pediatric patients receiving care in the Emergency Service of the Complejo Hospitalario de Navarra due to for reasons of accidental injury was conducted. The study covered a period of 1 year and assessed a total of 16 variables. There were a total of 8,876 patients, of whom 56.4% were males. Traumatic injuries such as fractures and craniocerebral trauma were identified as the most frequent injuries, occurring as a result of injuries mainly in the home. In females, there was a decrease in the incidence of injuries related to age. There was a greater incidence at the end of the day, during the weekend, and in the months of March to October. The epidemiological profile of pediatric patients who met with accidents in Navarra, Spain, is described. The knowledge of the main areas and factors related to injuries allows us to improve preventive measures, which would contribute to better control in this region of Spain.

  7. [Daily number of accidental injuries among elementary school children and school size factors in elementary schools].

    PubMed

    Ishigure, Kiyoshi

    2007-01-01

    The purpose of this study is to clarify the association between the daily number of accidental injuries and school size factors in elementary schools. The accidental injuries that occurred during the school day among elementary school children were investigated in twenty-one schools for two-month periods (from October to November) in 1999 and 2004. The relationship between the number of accidental injuries and school size factors (i.e. the numbers of school children and children per class) was analyzed by nonlinear regression analysis. The number of children injured and the frequency of accidental injuries were evaluated by school size. The ratio of the average number of injuries to all injuries was 1.79 per 100 children per day. The number of injuries in the small-sized schools was 2.36 per 100 children per day, and were respectively 1.29 and 1.57 in the middle- and large-sized schools. The number of injuries was small in middle-sized schools. As a result of the nonlinear regression analysis, a statistically significant quadratic equation was provided between the number of injuries per 100 children per day and the number of children per class. The number of injuries showed a minimum value for 26.7 children per class. The number of children injured during the investigation period was larger in the small-sized schools. In the small-sized schools, in comparison with the middle- and large-sized schools, the number of accidental injuries was smaller for boys. In the large-sized schools, there were more injuries inside the school building and during the lesson break times. large. In addition, it is suggested that the number of children injured was larger in small-sized schools.

  8. [Accidental injuries in older adults: a challenge for the health systems].

    PubMed

    Ruelas González, María Guadalupe; Salgado de Snyder, V Nelly

    2008-01-01

    To identify factors (sociodemographic, health, and social support) associated with the presence of accidental injuries in older adults living in deprived urban neighborhoods in four Mexican municipalities. Cross-sectional survey carried out in 2004-2005, with a non-probabilistic, intentional sample of 799 male and female elderly living in deprived urban areas in four Mexican municipalities. For the statistical analysis, non-parametric tests and multivariate logistic regression models were used. More than a third (37%) of the sample reported injuries; with falls being the main cause. Home was the venue where most accidents took place (52%). Risk factors for accidental injuries were: advanced age, working, greater number of illnesses, consumption of more medicines and remedies, self-perception of "poor" health , consumption of alcoholic beverages, inadequate family support and being a caretaker of others. The multi-causality of accidental injuries in older adults demands the participation of all sectors of society, and particularly public health interventions.

  9. Laser-Induced Photic Injury Phenocopies Macular Dystrophy.

    PubMed

    Zhang, Lijuan; Zheng, Andrew; Nie, Hongping; Bhavsar, Kavita V; Xu, Yu; Sliney, David H; Trokel, Stephen L; Tsang, Stephen H

    2016-01-01

    To describe the phenotypes associated with laser-induced retinal damage in children. Five patients with maculopathy and reduced visual acuity associated with laser pointer use were evaluated. Best-corrected visual acuity, retinal structure, and function were monitored with color fundus, infrared (IR), and red-free images, fundus autofluorescence (AF), spectral domain-optical coherence tomography (SD-OCT), and full-field electroretinography (ERG). All five laser pointer injury patients had retinal lesions resembling a macular dystrophy (one bilateral and four unilateral). These lesions were irregular in shape but all had a characteristic dendritic appearance with linear streaks radiating from the lesion. Photoreceptor damage was present in all patients, but serial OCT monitoring showed that subsequent photoreceptor recovery occurred over time in the eyes of at least four patients. One patient also had bilateral pigment epithelial detachments (PED). Both hyper- and hypoautofluorecence were observed in the laser damage area. In general, OCT and IR images are quite useful to diagnose laser damage, but AF is not as sensitive. Laser pointer damage in children can occasionally be misdiagnosed as a macular dystrophy disease, but the distinctive lesions and OCT features are helpful for differentiating laser damage from other conditions.

  10. Laser-Induced Photic Injury Phenocopies Macular Dystrophy

    PubMed Central

    Zhang, Lijuan; Zheng, Andrew; Nie, Hongping; Bhavsar, Kavita V.; Xu, Yu; Sliney, David H.; Trokel, Stephen L.; Tsang, Stephen H

    2016-01-01

    Objective To describe the phenotypes associated with laser-induced retinal damage in children. Methods Five patients with maculopathy and reduced visual acuity associated with laser pointer use were evaluated. Best-corrected visual acuity, retinal structure, and function were monitored with color fundus, infrared (IR), and red-free images, fundus autofluorescence (AF), spectral domain-optical coherence tomography (SD-OCT), and full-field electroretinography (ERG). Results All five laser pointer injury patients had retinal lesions resembling a macular dystrophy (1 bilateral and 4 unilateral). These lesions were irregular in shape but all had a characteristic dendritic appearance with linear streaks radiating from the lesion. Photoreceptor damage was present in all patients, but serial OCT monitoring showed that subsequent photoreceptor recovery occurred over time in the eyes of at least 4 patients. 1 patient also had bilateral pigment epithelial detachments (PED). Both hyper- and hypoautofluorecence were observed in the laser damage area. Conclusions In general, OCT and IR images are quite useful to diagnose laser damage, but AF is not as sensitive. Laser pointer damage in children can occasionally be misdiagnosed as a macular dystrophy disease, but the distinctive lesions and OCT features are helpful for differentiating laser damage from other conditions. PMID:26927809

  11. Non-Accidental Head Injury in New Zealand: The Outcome of Referral to Statutory Authorities

    ERIC Educational Resources Information Center

    Kelly, Patrick; MacCormick, Judith; Strange, Rebecca

    2009-01-01

    Objectives: To describe the outcome of referral to the statutory authorities for infants under 2 years with non-accidental head injury (NAHI), and to establish whether the authorities held sufficient information to develop a risk profile for these cases. Methods: Retrospective review of cases admitted to hospital in Auckland, New Zealand from 1988…

  12. Non-Accidental Head Injury in New Zealand: The Outcome of Referral to Statutory Authorities

    ERIC Educational Resources Information Center

    Kelly, Patrick; MacCormick, Judith; Strange, Rebecca

    2009-01-01

    Objectives: To describe the outcome of referral to the statutory authorities for infants under 2 years with non-accidental head injury (NAHI), and to establish whether the authorities held sufficient information to develop a risk profile for these cases. Methods: Retrospective review of cases admitted to hospital in Auckland, New Zealand from 1988…

  13. Skeletal survey normal variants, artefacts and commonly misinterpreted findings not to be confused with non-accidental injury.

    PubMed

    Quigley, Alan J; Stafrace, Samuel

    2014-01-01

    Radiology plays a key part in the investigation of non-accidental injury. Many normal variants and artefacts can simulate an abnormality associated with non-accidental injury. It is essential that radiologists reporting skeletal surveys in cases of suspected child abuse are aware of these. We present a pictorial essay to aid the reporting radiologist in the differentiation between normal variants or artefacts and true traumatic injury. We show plain film examples of potential pitfalls throughout the body.

  14. Mitigation of Lung Injury after Accidental Exposure to Radiation

    PubMed Central

    Mahmood, J.; Jelveh, S.; Calveley, V.; Zaidi, A.; Doctrow, S. R.; Hill, R. P.

    2011-01-01

    There is a serious need to develop effective mitigators against accidental radiation exposures. In radiation accidents, many people may receive nonuniform whole-body or partial-body irradiation. The lung is one of the more radiosensitive organs, demonstrating pneumonitis and fibrosis that are believed to develop at least partially because of radiation-induced chronic inflammation. Here we addressed the crucial questions of how damage to the lung can be mitigated and whether the response is affected by irradiation to the rest of the body. We examined the widely used dietary supplement genistein given at two dietary levels (750 or 3750 mg/kg) to Fischer rats irradiated with 12 Gy to the lung or 8 Gy to the lung + 4 Gy to the whole body excluding the head and tail (whole torso). We found that genistein had promising mitigating effects on oxidative damage, pneumonitis and fibrosis even at late times (36 weeks) when drug treatment was initiated 1 week after irradiation and stopped at 28 weeks postirradiation. The higher dose of genistein showed no greater beneficial effect. Combined lung and whole-torso irradiation caused more lung-related severe morbidity resulting in euthanasia of the animals than lung irradiation alone. PMID:22013884

  15. A CASE OF ACCIDENTAL OCULAR INJURY FROM COSMETIC LASER BURN.

    PubMed

    Shum, Jennifer W H; Iu, Lawrence P L; Cheung, Danny N; Wong, Ian Y H

    2016-01-01

    To report the clinical course of a patient sustaining a ocular laser injury from 1,064-nm Nd:YAG cosmetic laser machine. A 31-year-old beauty parlor aesthetician was operating an Nd:YAG cosmetic laser machine of 1,064 nm wavelength. However, the probe was held in the opposite direction, and on firing, the laser shot fired into her left eye. The patient heard a "pop" sound followed by immediate floaters and blurring of vision. Her clinical course was followed for 6 weeks, with investigations including optical coherence tomography, fluorescein angiogram, and Humphrey's visual field examination performed. Optical coherence tomography taken over the injured area showed thickened retina and preretinal hyperreflectivities. Fluorescein angiogram showed hypofluorescence superonasal to the disk with late staining of vessels. Humphrey's visual field showed a dense scotoma emanating from the blind spot. The lesion eventually scarred down, and the patient's vision recovered. The eye is the most susceptible body part to laser light injury. A review of reported laser accidents revealed the majority to be ocular injuries. The retina is particularly vulnerable, as laser light with wavelength between 400 nm and 1,400 nm is focused by the cornea and lens onto the retina, increasing the retinal irradiance as a result. Most injuries were parafoveal, suggesting that most injuries occurred during laser beam alignment. The prognosis is generally favorable. As laser use becomes more widespread and its application increasingly heterogeneous, regulation of laser use and monitoring of laser safety are crucial but at the same time challenging.

  16. Youth Versus Adult “Weightlifting” Injuries Presenting to United States Emergency Rooms: Accidental Versus Nonaccidental Injury Mechanisms

    PubMed Central

    Myer, Gregory D.; Quatman, Carmen E.; Khoury, Jane; Wall, Eric J.; Hewett, Timothy E.

    2014-01-01

    Myer, GD, Quatman, CE, Khoury, J, Wall, EJ, and Hewett, TE. Youth versus adult “weightlifting” injuries presenting to united states emergency rooms: accidental versus nonaccidental injury mechanisms. J Strength Cond Res 23(7): 2054–2060, 2009—Resistance training has previously been purported to be unsafe and ineffective in children. The purpose of this investigation was to evaluate resistance training-related injuries presenting to U.S. emergency rooms by age, type, and mechanism of injury. We hypothesized that older athletes would sustain greater percentages of joint sprains and muscle strains, whereas younger athletes would sustain a greater percentage of accidental injuries that would result in an increased percentage of fractures in youths. The U.S. Consumer Product Safety Commission (CPSC) National Electronic Injury Surveillance System was queried from 2002 to 2005 using the CPSC code for “Weightlifting.” Subjects between the ages of 8 and 30 were grouped by age categories 8 to 13 (elementary/middle school age), 14 to 18 (high school), 19 to 22 (college), and 23 to 30 (adult). Injuries were classified as “accidental” if caused by dropped weight or improper equipment use. Multiple logistic regression was used to compare accidental injuries between age groups. The sample consisted of 4, 111 patients. Accidental injuries decreased (p < 0.05) with age: 8 to 13 > 14 to 18 > 19 to 22 years = 23 to 30 years. Conversely, sprain/strain injuries increased in each successive age group (p < 0.05). Evaluation of only the nonaccidental injuries (n = 2, 565) showed that the oldest categories (19–22 and 23–30 yr) demonstrated a greater percentage of sprains and strains relative to younger age categories (p < 0.001). Two thirds of the injuries sustained in the 8 to 13 group were to the hand and foot and were most often related to “dropping” and “pinching” in the injury descriptions, and there was an increased percentage of fractures in the 8 to 13

  17. Involving parents in indicated early intervention for childhood PTSD following accidental injury.

    PubMed

    Cobham, Vanessa E; March, Sonja; De Young, Alexandra; Leeson, Fiona; Nixon, Reginald; McDermott, Brett; Kenardy, Justin

    2012-12-01

    Accidental injuries represent the most common type of traumatic event to which a youth is likely to be exposed. While the majority of youth who experience an accidental injury will recover spontaneously, a significant proportion will go on to develop Post-Traumatic Stress Disorder (PTSD). And yet, there is little published treatment outcome research in this area. This review focuses on two key issues within the child PTSD literature--namely the role of parents in treatment and the timing of intervention. The issue of parental involvement in the treatment of child PTSD is a question that is increasingly being recognized as important. In addition, the need to find a balance between providing early intervention to at risk youth while avoiding providing treatment to those youth who will recover spontaneously has yet to be addressed. This paper outlines the rationale for and the development of a trauma-focused CBT protocol with separate parent and child programs, for use with children and adolescents experiencing PTSD following an accidental injury. The protocol is embedded within an indicated intervention framework, allowing for the early identification of youth at risk within a medical setting. Two case studies are presented in order to illustrate key issues raised in the review, implementation of the interventions, and the challenges involved.

  18. Amplitude-integrated EEG revealed nonconvulsive status epilepticus in children with non-accidental head injury.

    PubMed

    Igarashi, Ayuko; Okumura, Akihisa; Komatsu, Mitsutaka; Tomita, Osamu; Abe, Shinpei; Ikeno, Mitsuru; Saito, Masako; Nakazawa, Tomoyuki; Shimizu, Toshiaki

    2014-11-01

    We describe the clinical course and amplitude-integrated EEG findings in three children with non-accidental head injury and discuss on the importance of continuous aEEG monitoring in infants. NCSE was defined as a continuous 30-min seizure or briefer seizures occurring consecutively comprising at least 30 min of any 1-h period. Non-accidental head injury was diagnosed on the basis of neuroimaging findings such as subdural hemorrhage. Antiepileptic treatment was performed with continuous amplitude-integrated EEG monitoring. The age of the patients ranged from 48 days to nine months. All of them had loss of consciousness and seizures on presentation. Nonconvulsive status epilepticus without clinical symptoms were recognized in all patients. Vigorous antiepileptic treatment against nonconvulsive status epilepticus was made in two patients, whereas nonconvulsive status epilepticus disappeared within one hour without additional treatment in one. Our experience indicates that nonconvulsive status epilepticus were not uncommon in children with non-accidental head injury. Continuous amplitude-integrated EEG monitoring will be one of the useful methods in encephalopathic children in order to estimate seizure burden objectively and to treat seizures appropriately. Copyright © 2014 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.

  19. Burns in children: the importance of assessing for non-accidental injuries

    PubMed Central

    Heymann, Eric; Marsdin, Emma Lucy

    2012-01-01

    Children represent 30% of all burn cases seen by accident and emergency physicians in the UK every year, with toddlers being most at risk within this age group. With the emergence of walking autonomy, the need for constant supervision is sometimes not enough to prevent this type of injury from happening. However, in remembering the importance of children’s health and safety, non-accidental injury is always to remain a differential diagnosis. The authors review a paediatric burns case underlying the importance of keeping an open mind to allow a proper clinical diagnosis to be formed. PMID:22604512

  20. Accidental Inclusions Following Blast Injury in Esthetical Zones: Ablation by a Hydrosurgery System

    PubMed Central

    Siemers, Frank; Mauss, Karl L.; Liodaki, Eirini; Ottomann, Christian; Bergmann, Philipp A.; Mailänder, Peter

    2012-01-01

    In case of blast injuries, traumatic tattoos can result from accidental inclusions of intradermal pigmented particles. To avoid these tattoos, especially in esthetical areas like the head and neck region and the hands, the primary goal in our treatment is to remove all particles and foreign bodies. Superficial foreign bodies can easily be removed by brushes or dermabrasion. Deeper lesions are a challenge for plastic surgeons, because they are not so easily removed. Ablation by a water jet surgical tool, the Versajet-system (Smith & Nephew Inc, Andover, MA), enables the removal of nearly all particles and foreign bodies, which sustained a blast injury of the face or the hands. Aim of this paper is to describe the method of using this hydrosurgery system in blast injuries in esthetical zones and its advantages by presenting cases of two patients of us. PMID:22848777

  1. Apoptosis and accidental cell death in cultured human keratinocytes after thermal injury.

    PubMed

    Matylevitch, N P; Schuschereba, S T; Mata, J R; Gilligan, G R; Lawlor, D F; Goodwin, C W; Bowman, P D

    1998-08-01

    The respective roles of apoptosis and accidental cell death after thermal injury were evaluated in normal human epidermal keratinocytes. By coupling the LIVE/DEAD fluorescence viability assay with the terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling (TUNEL) method and ultrastructural morphology, these two processes could be distinguished. Cells were grown on glass coverslips with a microgrid pattern so that the results of several staining procedures performed sequentially could be visualized in the same cells after heating at temperatures of up to 72 degrees C for 1 second. After exposure to temperatures of 58 to 59 degrees C, cells died predominantly by apoptosis; viable cells became TUNEL positive, indicating degradation of DNA. After exposure to temperatures of 60 to 66 degrees C, both TUNEL-positive viable cells and TUNEL-positive nonviable cells were observed, indicating that apoptosis and accidental cell death were occurring simultaneously. Cells died almost immediately after exposure to temperatures above 72 degrees C, presumably from heat fixation. The fluorescent mitochondrial probe MitoTracker Orange indicated that cells undergoing apoptosis became TUNEL positive before loss of mitochondrial function. Nucleosomal fragmentation of DNA analyzed by enzyme-linked immunosorbent assay and gel electrophoresis occurred after exposure to temperatures of 58 to 59 degrees C. The characteristic morphological findings of cells undergoing apoptosis, by transmission electron microscopy, included cellular shrinkage, cytoplasmic budding, and relatively intact mitochondria. Depending on temperature and time of exposure, normal human epidermal keratinocytes may die by apoptosis, accidental cell death, or heat fixation.

  2. Ocular and cerebral trauma in non-accidental injury in infancy: underlying mechanisms and implications for paediatric practice.

    PubMed Central

    Green, M A; Lieberman, G; Milroy, C M; Parsons, M A

    1996-01-01

    AIMS: To determine the sites, mechanisms, and clinical significance of injuries to the eyes and brains of children with non-accidental injuries in relation to differing levels of trauma. METHODS: A forensic pathological study of injuries in the eyes and brains of 23 consecutive children dying of non-accidental injuries over a 4 year period (1988-92) under the jurisdiction of Yorkshire and Humberside coroners. RESULTS: Sixteen children died from cerebral injuries and seven died from non-cerebral causes. There were high incidences of retinal detachment (63%) and subhyaloid (75%), intraretinal (75%), and perineural (68%) haemorrhages in CNS deaths. Local subhyaloid haemorrhages and retinal detachment were more common at the periphery and optic disc than at the equator. There was a strong correlation between CNS and eye trauma scores in all 23 children (r = 0.7551, p < 0.0001). Ranking of injuries by severity suggests progressively more trauma required for (a) subdural haemorrhage, (b) subhyaloid, intraretinal, perineural haemorrhages, and (c) retinal detachment. At highest trauma levels choroidal and vitreous haemorrhages were associated with additional cerebral lacerations, intracerebral and subarachnoid haemorrhages. CONCLUSIONS: In non-accidental (and probably accidental) infantile head injury the earliest eye injuries (coinciding with subdural haemorrhage) could be missed if indirect ophthalmoscopy is not performed. Retinal detachment and multiple (particularly choroidal/vitreous) haemorrhages may indicate additional cerebral lacerations and/or intracerebral haemorrhage. Vitreous traction is the likely cause of intraocular pathology. PMID:8703874

  3. Non-accidental Trauma Injury Patterns and Outcomes: A Single Institutional Experience.

    PubMed

    Ward, Austin; Iocono, Joseph A; Brown, Samuel; Ashley, Phillip; Draus, John M

    2015-09-01

    Non-accidental trauma (NAT) victims account for a significant percentage of our pediatric trauma population. We sought to better understand the injury patterns and outcomes of NAT victims who were treated at our level I pediatric trauma center. Trauma registry data were used to identify NAT victims between January 2008 and December 2012. Demographic data, injury severity, hospital course, and outcomes were evaluated. One hundred and eighty-eight cases of suspected NAT were identified. Children were mostly male and white. The median age was 1.1 years; the median Injury Severity Score was 9. Traumatic brain injuries, lower extremity fractures, and skull fractures were the most common injuries. Twenty-seven per cent required medical procedures; most were performed by orthopedic surgery. Twenty-four per cent required admission to the pediatric intensive care unit. The median length of stay was two days. The mortality rate was 9.6 per cent. We generated a hot spot map of our catchment area and identified areas of our state where NAT occurs at increased rates. NAT victims sustain significant morbidity and mortality. Due to the severity of injuries, pediatric trauma surgeons should be involved in the evaluation and management of these children. Much work is needed to prevent the death and disability incurred by victims of child abuse.

  4. Menace of childhood non-accidental traumatic brain injuries: A single unit report.

    PubMed

    Ibrahim, Musa; Mu'azu, Adamu Ladan; Idris, Nura; Rabiu, Musa Uba; Jibir, Binta Wudil; Getso, Kabir Ibrahim; Mohammad, Mohammad Aminu; Owolabi, Femi Luqman

    2015-01-01

    Childhood traumatic brain injury (TBI) has high rate of mortality and morbidity worldwide. There are dearths of reports from developing countries with large paediatric population on trauma; neurosurgery trauma of nonaccidental origin is not an exemption. This study analysed menace of non-accidental TBI in the paediatric population from our center. This is a single unit, retrospective study of the epidemiology of non-accidental TBI in children starting from September, 2008 to March, 2014. The management outcomes of the epidemiology of the non-accidental TBI were analysed. Total of 109 children age range from 0 (intra-natal) to 16 years with a mean of 5.8 ± 4.6 years (median, 5 years) were enrolled into the study. 34 (31.2%) were domestic violence, 26 (23.9%) street assaults, 16 (14.7%) were due to animal assaults and mishaps, 17 (15.6%) fall from heights. Seven (6.4%) cases of collapsed buildings were also seen during the period. Four (3.7%) industrial accidents and two (1.8%) were self-inflicted injuries. There were also three (2.8%) cases of iatrogenic TBI out of which two infants (1.8%) sustained TBI from cesarean section procedure while one patient (0.9%) under general anaesthesia felt from the operation bed resulting to severe TBI. Child abuse, unprotected child labour, parental/care-givers negligence are the main cause of nonaccidental TBI. Human right activists and government agents should be incorporated in curtailing the menace.

  5. Menace of childhood non-accidental traumatic brain injuries: A single unit report

    PubMed Central

    Ibrahim, Musa; Mu’azu, Adamu Ladan; Idris, Nura; Rabiu, Musa Uba; Jibir, Binta Wudil; Getso, Kabir Ibrahim; Mohammad, Mohammad Aminu; Owolabi, Femi Luqman

    2015-01-01

    Background: Childhood traumatic brain injury (TBI) has high rate of mortality and morbidity worldwide. There are dearths of reports from developing countries with large paediatric population on trauma; neurosurgery trauma of nonaccidental origin is not an exemption. This study analysed menace of non-accidental TBI in the paediatric population from our center. Materials and Methods: This is a single unit, retrospective study of the epidemiology of non-accidental TBI in children starting from September, 2008 to March, 2014. The management outcomes of the epidemiology of the non-accidental TBI were analysed. Results: Total of 109 children age range from 0 (intra-natal) to 16 years with a mean of 5.8 ± 4.6 years (median, 5 years) were enrolled into the study. 34 (31.2%) were domestic violence, 26 (23.9%) street assaults, 16 (14.7%) were due to animal assaults and mishaps, 17 (15.6%) fall from heights. Seven (6.4%) cases of collapsed buildings were also seen during the period. Four (3.7%) industrial accidents and two (1.8%) were self-inflicted injuries. There were also three (2.8%) cases of iatrogenic TBI out of which two infants (1.8%) sustained TBI from cesarean section procedure while one patient (0.9%) under general anaesthesia felt from the operation bed resulting to severe TBI. Conclusion: Child abuse, unprotected child labour, parental/care-givers negligence are the main cause of nonaccidental TBI. Human right activists and government agents should be incorporated in curtailing the menace. PMID:25659545

  6. Can we prevent accidental injury to adolescents? A systematic review of the evidence.

    PubMed Central

    Munro, J.; Coleman, P.; Nicholl, J.; Harper, R.; Kent, G.; Wild, D.

    1995-01-01

    OBJECTIVES: As part of the Department of Health strategy The Health of the Nation, a systematic review of published and unpublished literature relating to the effectiveness of interventions in reducing accidental injury in the population aged 15-24 years was carried out. METHODS: The literature was reviewed under the standard setting headings of road, work, home, and sports and leisure, and graded for quality of evidence and strength of recommendation using a scale published in the UK national epidemiologically based needs assessment programme. RESULTS: The most effective measures appear to be legislative and regulatory controls in road, sport, and workplace settings. Environmental engineering measures on the road and in sports have relatively low implementation costs and result in fewer injuries at all ages. There is little evidence that purely educational measures reduced injuries in the short term. Community based approaches may be effective in all age groups, and incentives to encourage safer behaviour hold promise but require further evaluation. The potential of multifactorial approaches seems greater than narrowly based linear approaches. CONCLUSIONS: Few interventions to reduce injury in adolescents have been rigorously evaluated using good quality randomised controlled trials, and where such evidence is available, fewer have been shown to be definitely worthwhile. Many studies relied on surrogate measures rather than actual injury rates, and substantial issues relating to the efficacy or implementation of preventive measures in adolescent and young adult populations remain unresolved. PMID:9346041

  7. Caregivers' voices: The experiences of caregivers of children who sustained serious accidental and non-accidental head injury in early childhood.

    PubMed

    Wharewera-Mika, Julie; Cooper, Erana; Kool, Bridget; Pereira, Susana; Kelly, Patrick

    2016-04-01

    Head injury is a leading cause of mortality and acquired neurological impairment in children. Head-injured children may have neurobehavioural deficits that persist for years following injury. Head injury can result in significant and persistent caregiver burden, including mental health issues, family stress and disorganisation, and unmet social and healthcare service needs. Few studies have examined the healthcare and social service needs of children and their families following head injury sustained at an early age. This qualitative study aims to describe the experiences of caregivers of children who sustained a serious head injury (particularly non-accidental head injury) before the age of 2 years. Caregivers were interviewed up to 15 years following the initial injury. Semi-structured interviews with 21 caregivers of 15 children (aged 3-15 years at the time of interview) were completed. Thematic analysis of interview data generated three key themes: impact, support and information. The study's findings reveal the broad impact of serious childhood head injury on caregivers, specifically the significant distress and burden brought about through lack of information, challenges in accessing support and inconsistent care. Recommendations for developing a quality 'model of care' and improving ease of access to supports for caregivers are provided.

  8. Selective cone photoreceptor injury in acute macular neuroretinopathy.

    PubMed

    Hansen, Sean O; Cooper, Robert F; Dubra, Alfredo; Carroll, Joseph; Weinberg, David V

    2013-09-01

    To evaluate retinal structural and functional abnormalities in a patient with acute macular neuroretinopathy. An adaptive optics scanning light ophthalmoscope was used to image the photoreceptor mosaic and assess rod and cone structure. Spectral-domain optical coherence tomography was used to examine retinal lamination. Microperimetry was used to assess function across the macula. Microperimetry showed reduced function of localized areas within retinal lesions corresponding to subjective scotomas. Spectral-domain optical coherence tomography imaging revealed attenuation of two outer retinal bands typically thought to reflect photoreceptor structure. Adaptive optics scanning light ophthalmoscope images of the photoreceptor mosaic revealed a heterogeneous presentation within these lesions. There were areas containing non-waveguiding cones and other areas of decreased cone density where the remaining rods had expanded to fill in the vacant space. Within these lesions, cone densities were shown to be significantly lower than eccentricity-matched areas of normal retina, as well as accepted histologic measurements. A 6-month follow-up revealed no change in rod or cone structure. Imaging of acute macular neuroretinopathy using an adaptive optics scanning light ophthalmoscope shows a preferential disruption of cone photoreceptor structure within the region of decreased retinal sensitivity (as measured by microperimetry). Adaptive optics-based imaging tools provide a noninvasive way to assess photoreceptor structure at a level of detail that is not resolved by use of conventional spectral-domain optical coherence tomography or other clinical measures.

  9. Neuropathological changes in a lamb model of non-accidental head injury (the shaken baby syndrome).

    PubMed

    Finnie, J W; Blumbergs, P C; Manavis, J; Turner, R J; Helps, S; Vink, R; Byard, R W; Chidlow, G; Sandoz, B; Dutschke, J; Anderson, R W G

    2012-08-01

    Non-accidental head injury (NAHI), also termed the "shaken baby syndrome", is a major cause of death and severe neurological dysfunction in children under three years of age, but it is debated whether shaking alone is sufficient to produce brain injury and mortality or whether an additional head impact is required. In an attempt to resolve this question, we used a lamb model of NAHI since these animals have a relatively large gyrencephalic brain and weak neck muscles resembling those of a human infant. Three anaesthetised lambs of lower body weight than others in the experimental group died unexpectedly after being shaken, proving that shaking alone can be lethal. In these lambs, axonal injury, neuronal reaction and albumin extravasation were widely distributed in the hemispheric white matter, brainstem and at the craniocervical junction, and of much greater magnitude than in higher body weight lambs which did not die. Moreover, in the eyes of these shaken lambs, there was damage to retinal inner nuclear layer neurons, mild, patchy ganglion cell axonal injury, widespread Muller glial reaction, and uveal albumin extravasation. This study proved that shaking of a subset of lambs can result in death, without an additional head impact being required.

  10. Accidental circular saw hand injuries: trauma mechanisms, injury patterns, and accident insurance.

    PubMed

    Frank, Matthias; Lange, Joern; Napp, Matthias; Hecht, Juliane; Ekkernkamp, Axel; Hinz, Peter

    2010-05-20

    Hand injuries due to circular saws are a common reason for patients seeking medical care in emergency departments. With respect to cases of insurance fraud, these injuries are of medico-legal interest. It is the aim of this study to investigate the critical circumstances of the incidents, the accident mechanism, and the specific injury patterns of circular saw related hand injuries with regard to accident insurance coverage. Circular saw related hand injuries for the years 1999 through 2007 were followed-up and assessed in detail. Type, severity and pattern of the injury were assessed. An accident analysis investigated characteristic of the activities, of the saws, of the stock/cutting material, operational activities of the operators prior to/at the time of the incident, and detailed information on the insurance status. The follow-up study encompassed 114 patients. A majority of these were covered by private or statutory accident insurances. Compensation payments were made in all cases. All lesions involved one hand, mainly the left non-dominant hand. Thumb and index were at highest risk for injury. One-finger injuries occurred mainly at the middle or distal phalanx. With increasing number of affected fingers, the level of the injury moved closer to the proximal phalanx. A majority of injuries occurred during do-it-yourself activities. Among blade contact injuries, the so-called kickback-mechanism was at highest risk. Positive circumstantial indications of a self-inflicted injury, which are often cited in the literature are less conclusive for the medico-legal decision finding. The detailed anatomic description of any lesions and the alleged accident mechanism as initially described by the patients in the emergency setting is the basis for any later accident reconstruction.

  11. Biomechanical studies in an ovine model of non-accidental head injury.

    PubMed

    Anderson, R W G; Sandoz, B; Dutschke, J K; Finnie, J W; Turner, R J; Blumbergs, P C; Manavis, J; Vink, R

    2014-08-22

    This paper presents the head kinematics of a novel ovine model of non-accidental head injury (NAHI) that consists only of a naturalistic oscillating insult. Nine, 7-to-10-day-old anesthetized and ventilated lambs were subjected to manual shaking. Two six-axis motion sensors tracked the position of the head and torso, and a triaxial accelerometer measured head acceleration. Animals experienced 10 episodes of shaking over 30 min, and then remained under anesthesia for 6h until killed by perfusion fixation of the brain. Each shaking episode lasted for 20s resulting in about 40 cycles per episode. Each cycle typically consisted of three impulsive events that corresponded to specific phases of the head's motion; the most substantial of these were interactions typically with the lamb's own torso, and these generated accelerations of 30-70 g. Impulsive loading was not considered severe. Other kinematic parameters recorded included estimates of head power transfer, head-torso flexion, and rate of flexion. Several styles of shaking were also identified across episodes and subjects. Axonal injury, neuronal reaction and albumin extravasation were widely distributed in the hemispheric white matter, brainstem and at the craniocervical junction and to a much greater magnitude in lower body weight lambs that died. This is the first biomechanical description of a large animal model of NAHI in which repetitive naturalistic insults were applied, and that reproduced a spectrum of injury associated with NAHI.

  12. Patterns of injury seen in deaths from accidental falls down a staircase: a study from South Delhi.

    PubMed

    Behera, C; Rautji, R; Dogra, T D

    2009-04-01

    The present study is a retrospective analysis of 92 cases of death from an accidental fall down a staircase, which were autopsied at the All India Institute of Medical Sciences, New Delhi, India, during a ten-year period from 1996 to 2005. The cases were analysed with regard to age, sex, location, cause of death and pattern of injury. Males (62, 67.39%) outnumbered females (30, 32.61%). The commonest age group involved was 31-40 years (28.26%) followed by 21-30 years (18.47%) and 51-60 years (14.13%). The lowest number of cases (4.34%) was in the 11-20 years age group. All deaths were accidental in nature. The most common cause of death was head injury (80.43%) followed by haemorrhagic shock resulting from intra-abdominal and intra-thoracic visceral injuries (9.78%) and injury to the neck (4.34%). The parietal and temporal bones were those most frequently fractured in head injury cases. Cerebral oedema (n = 56, 70.88%), followed by subdural haematoma (n = 34, 43.03%) were the two most common intra-cranial injuries. Two females were accidentally hanged while descending stairs. The majority of accidents happened at home (n = 90, 97.82%). Alcohol was detected in ten cases (17.54%). Fatalities from falls down a staircase were most often reported in the rainy season.

  13. [Non-accidental injuries in childhood and the nature of their appearance].

    PubMed

    Eberl, R; Huber-Zeyringer, A; Curcic, N; Höllwarth, M E

    2010-02-01

    Child abuse has been the leading cause of death in pediatric patients for a long time. The subject is complex in its etiology, appearance, consequences and prognosis. To be confronted with the patient is emotional. Inpatient treatment at a pediatric centre should be performed in any suspicious cases of non-accidental injury. The child protection group consists of one pediatric specialist as well as four ward physicians, one psychotherapist, two staff nurses and one graduated social worker. The team's aims are the early detection of violence towards children, the safeguarding of child protection policies and the provision of family centred, interdisciplinary treatment. During a 6-year period (2001-2006) 476 children were treated at our department. Cruelty was found in 47%, sexual abuse in 28% and willful neglect in 25%. Only 12% of the patients presented obvious injuries. In 88% secondary symptoms resulted in the correct diagnosis. Child protection groups are important institutions for dealing with the complex matter of child abuse. The burden and responsibility for the single person can be reduced within the team. Medical practitioners outside the hospital may give a referral without a loss of confidence.

  14. Accidental falls related to shovelling snow from rooftops: analysis of injuries in an extraordinary epidemic in southern Finland.

    PubMed

    Aulanko, M; Handolin, L; Söderlund, T; Pajarinen, J

    2012-01-01

    Exceptional amount of snow led to snow removal attempts from the rooftops resulting in a relative unique and extraordinary epidemic of accidental falls in winter of 2010. The injury pattern, hospital care, surgical operations, and the total costs of the primary hospital stay of accidentally fallen patients treated in Helsinki University Hospital trauma unit were analyzed. Forty-six patients were admitted to hospital during the study period of three months. Majority of the patients were males (N = 43, 93%) with the average age of 52.9 years. Seven patients were admitted to ICU. The average length of primary hospital stay was 4.7 days with 0% mortality. Total amount of fractures was 65 (63%) of all 97 injuries. The most common injuries were fractures of upper and lower extremity, and spinal column. Preventing similar unnecessary epidemics of accidental falls in the future it is important to have professional opinion of the need of snow removal along with understanding of the risk of injury. Wearing appropriate safety equipments, and use professional help when necessary is advisable.

  15. Risk factor for accidental injuries within senior citizens' homes: analysis of the Canadian Survey on Ageing and Independence.

    PubMed

    Fletcher, Paula C; Hirdes, John P

    2005-02-01

    Using data from the Survey on Ageing and Independence (SAI), risk factors for unintentional injuries occurring within the homes of individuals older than 65 are identified. For the SAI, conducted by Statistics Canada in 1991, data were collected on a representative sample of approximately 20,000 individuals between ages 45 and 102. For each household contacted, one individual older than 45 was interviewed via the telephone. For the present analysis, only individuals older than 65 (n = 10,059) were used. Approximately 5% of senior citizens experienced an injury that limited their activity for at least 1 day. Using logistic regression, the following risk factors for injury were identified: education, alcohol consumption, smoking, rest and sleep patterns, support, and interactions between age and gender, activity limitations and age, and home maintenance and gender. The present findings are important to the body of research concerning injuries among older adults. The results expand current univariate analysis of data identifying risk factors for injuries within the literature and provide comprehensive information pertaining to risk factors for accidental injuries at the multivariate level. Identification of risk factors provides health care professionals, particularly front line nurses, with insight into factors that, if modified, have the potential to decrease accidental injuries and improve or maintain quality of life.

  16. Molecular Response of Chorioretinal Endothelial Cells to Complement Injury: Implications for Macular Degeneration

    PubMed Central

    Zeng, Shemin; Whitmore, S. Scott; Sohn, Elliott H.; Riker, Megan J.; Wiley, Luke A.; Scheetz, Todd E.; Stone, Edwin M.; Tucker, Budd A.; Mullins, Robert F.

    2016-01-01

    Age-related macular degeneration (AMD) is a common, blinding disease of the elderly in which macular photoreceptor cells, retinal pigment epithelium, and choriocapillaris endothelial cells ultimately degenerate. Recent studies have found that degeneration of the choriocapillaris occurs early in this disease and that this endothelial cell dropout is concomitant with increased deposition of the complement membrane attack complex (MAC) at the choroidal endothelium. However, the impact of MAC injury to choroidal endothelial cells is poorly understood. To model this event in vitro, and to study the downstream consequences of MAC injury, endothelial cells were exposed to complement from human serum, compared to heat inactivated serum which lacks complement components. Cells exposed to complement components in human serum showed increased labeling with antibodies directed against the MAC, time and dose dependent cell death as assessed by lactate dehydrogenase assay, and increased permeability. RNA-Seq analysis following complement injury revealed increased expression of genes associated with angiogenesis including matrix metalloproteases (MMPs) 3 and 9, and VEGF-A. The MAC-induced increase in MMP9 RNA expression was validated using C5 depleted serum compared to C5 reconstituted serum. Increased levels of MMP9 were also determined using Western blot and zymography. These data suggest that, in addition to cell lysis, complement attack on choroidal endothelial cells promotes an angiogenic phenotype in surviving cells. PMID:26564985

  17. Molecular response of chorioretinal endothelial cells to complement injury: implications for macular degeneration.

    PubMed

    Zeng, Shemin; Whitmore, S Scott; Sohn, Elliott H; Riker, Megan J; Wiley, Luke A; Scheetz, Todd E; Stone, Edwin M; Tucker, Budd A; Mullins, Robert F

    2016-02-01

    Age-related macular degeneration (AMD) is a common, blinding disease of the elderly in which macular photoreceptor cells, retinal pigment epithelium and choriocapillaris endothelial cells ultimately degenerate. Recent studies have found that degeneration of the choriocapillaris occurs early in this disease and that endothelial cell drop-out is concomitant with increased deposition of the complement membrane attack complex (MAC) at the choroidal endothelium. However, the impact of MAC injury to choroidal endothelial cells is poorly understood. To model this event in vitro, and to study the downstream consequences of MAC injury, endothelial cells were exposed to complement from human serum, compared to heat-inactivated serum, which lacks complement components. Cells exposed to complement components in human serum showed increased labelling with antibodies directed against the MAC, time- and dose-dependent cell death, as assessed by lactate dehydrogenase assay and increased permeability. RNA-Seq analysis following complement injury revealed increased expression of genes associated with angiogenesis including matrix metalloproteinase (MMP)-3 and -9, and VEGF-A. The MAC-induced increase in MMP9 RNA expression was validated using C5-depleted serum compared to C5-reconstituted serum. Increased levels of MMP9 were also established, using western blot and zymography. These data suggest that, in addition to cell lysis, complement attack on choroidal endothelial cells promotes an angiogenic phenotype in surviving cells. Copyright © 2015 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.

  18. Radiology in suspected non-accidental injury: theory and practice in The Netherlands.

    PubMed

    van Rijn, R R; Kieviet, N; Hoekstra, R; Nijs, H G T; Bilo, R A C

    2009-07-01

    This study evaluates radiological imaging in suspected non accidental injury (NAI) in children below the age of 2 years in the Netherlands. The study consisted of two parts; first an on-line questionnaire on suspected NAI, amongst radiological practices within the Netherlands. The second part of the study was a retrospective analysis of skeletal surveys in children under the age of 2 years, which were reviewed in an expert centre of forensic medicine on request of the public prosecutor. Out of 116 hospitals 45 (39%) radiologists completed the on-line questionnaire; 8 (8%) of the proposed skeletal surveys complied with the ACR criteria. A total of 29 skeletal surveys in 26 children were reviewed. The median age at the time of the radiographic exam was 3 months for both boys and girls. Only 2 (7%) studies complied with the ACR criteria. The results of our study show that, in theory as well as in practice, Dutch radiological practices show a large variation in imaging protocols for suspected NAI.

  19. Testing for osteogenesis imperfecta in cases of suspected non-accidental injury

    PubMed Central

    Marlowe, A; Pepin, M; Byers, P

    2002-01-01

    To evaluate if laboratory testing for osteogenesis imperfecta (OI) identifies children unrecognised by clinical examination in instances where non-accidental injury (NAI) is suspected as the likely cause of fracture, we carried out a retrospective review of available medical records and biochemical test results from 262 patients. Cultured fibroblasts were received for biochemical testing for OI from children in whom the diagnosis of NAI was suspected. Eleven of the samples had alterations in the amount or structure of type I collagen synthesised, consistent with the diagnosis of OI, and in 11 others we could not exclude OI. Referring physicians correctly identified children with OI in six of the 11 instances established by biochemical studies, did not identify OI by clinical examination in three, and there was inadequate clinical information to know in two others. Biochemical testing was inconclusive in 11 infants in whom the diagnosis of OI could not be excluded, none of whom were thought to be affected by the referring clinicians. Four children believed to have OI by clinical examination had normal biochemical studies, a false positive clinical diagnosis attributed, in large part, to the use of scleral hue (a feature that is age dependent) as a major diagnostic criterion. Given the inability to identify all children with OI by clinical examination in situations of suspected NAI, laboratory testing for OI (and other genetic predispositions for fractures) is a valuable adjunct in discerning the basis for fractures and may identify a small group of children with previously undiagnosed OI. PMID:12070242

  20. Non-accidental injury in children: what we do in Derby.

    PubMed Central

    Arthur, L J; Moncrieff, W M; Milburn, W; Bayliss, P S; Heath, J

    1976-01-01

    A scheme for dealing with cases of non-accidental injury in children in the Derby clinical area has been operating since 1971. A stable team of doctors, policemen, and social workers deal with each case. The parents are told at once that battering is suspected, and the police and social services department co-operate closely in establishing the facts, supporting the family, and protecting the child. A psychiatric assessment of the parents may help social workers decide on the long-term care of the child, and the forensic physician is invaluable if the case has to go to court. The team has made three recommendations about prevention and management of these cases: a specialist social service team should be set up to deal with these children and regain the skills and knowledge lost when children's departments were abolished in 1971; babies should be routinely weighed naked in infant welfare clinics; and juvenile courts should be able to order a psychiatric report on the parents in care proceedings. PMID:1276692

  1. Abusive head trauma and accidental head injury: a 20-year comparative study of referrals to a hospital child protection team

    PubMed Central

    John, Simon; Vincent, Andrea L; Reed, Peter

    2015-01-01

    Aim To describe children referred for suspected abusive head trauma (AHT) to a hospital child protection team in Auckland, New Zealand. Methods Comparative review of demographics, histories, injuries, investigations and diagnostic outcomes for referrals under 15 years old from 1991 to 2010. Results Records were available for 345 children. Referrals increased markedly (88 in the first decade, 257 in the second), but the diagnostic ratio was stable: AHT 60%, accidental or natural 29% and uncertain cause 11%. The probability of AHT was similar regardless of socio-economic status or ethnicity. In children under 2 years old with accidental head injuries (75/255, 29%) or AHT (180/255, 71%), characteristics of particular interest for AHT included no history of trauma (88/98, 90%), no evidence of impact to the head (84/93, 90%), complex skull fractures with intracranial injury (22/28, 79%), subdural haemorrhage (160/179, 89%) and hypoxic ischaemic injury (38/39, 97%). In children over 2 years old, these characteristics did not differ significantly between children with accidental head injuries (21/47, 45%) and AHT (26/47, 55%). The mortality of AHT was higher in children over 2 years old (10/26, 38%) than under 2 years (19/180, 11%). Conclusions The striking increase in referrals for AHT probably represents increasing incidence. The decision to refer a hospitalised child with a head injury for assessment for possible AHT should not be influenced by socio-economic status or ethnicity. Children over 2 years old hospitalised for AHT are usually injured by mechanisms involving impact and should be considered at high risk of death. PMID:26130384

  2. Abusive head trauma and accidental head injury: a 20-year comparative study of referrals to a hospital child protection team.

    PubMed

    Kelly, Patrick; John, Simon; Vincent, Andrea L; Reed, Peter

    2015-12-01

    To describe children referred for suspected abusive head trauma (AHT) to a hospital child protection team in Auckland, New Zealand. Comparative review of demographics, histories, injuries, investigations and diagnostic outcomes for referrals under 15 years old from 1991 to 2010. Records were available for 345 children. Referrals increased markedly (88 in the first decade, 257 in the second), but the diagnostic ratio was stable: AHT 60%, accidental or natural 29% and uncertain cause 11%. The probability of AHT was similar regardless of socio-economic status or ethnicity. In children under 2 years old with accidental head injuries (75/255, 29%) or AHT (180/255, 71%), characteristics of particular interest for AHT included no history of trauma (88/98, 90%), no evidence of impact to the head (84/93, 90%), complex skull fractures with intracranial injury (22/28, 79%), subdural haemorrhage (160/179, 89%) and hypoxic ischaemic injury (38/39, 97%). In children over 2 years old, these characteristics did not differ significantly between children with accidental head injuries (21/47, 45%) and AHT (26/47, 55%). The mortality of AHT was higher in children over 2 years old (10/26, 38%) than under 2 years (19/180, 11%). The striking increase in referrals for AHT probably represents increasing incidence. The decision to refer a hospitalised child with a head injury for assessment for possible AHT should not be influenced by socio-economic status or ethnicity. Children over 2 years old hospitalised for AHT are usually injured by mechanisms involving impact and should be considered at high risk of death. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  3. Social interaction in young children with inflicted and accidental traumatic brain injury: relations with family resources and social outcomes.

    PubMed

    Ewing-Cobbs, Linda; Prasad, Mary R; Mendez, Donna; Barnes, Marcia A; Swank, Paul

    2013-05-01

    Core social interaction behaviors were examined in young children 0-36 months of age who were hospitalized for accidental (n = 61) or inflicted (n = 64) traumatic brain injury (TBI) in comparison to typically developing children (n = 60). Responding to and initiating gaze and joint attention (JA) were evaluated during a semi-structured sequence of social interactions between the child and an examiner at 2 and 12 months after injury. The accidental TBI group established gaze less often and had an initial deficit initiating JA that resolved by the follow-up. Contrary to expectation, children with inflicted TBI did not have lower rates of social engagement than other groups. Responding to JA was more strongly related than initiating JA to measures of injury severity and to later cognitive and social outcomes. Compared to complicated-mild/moderate TBI, severe TBI in young children was associated with less responsiveness in social interactions and less favorable caregiver ratings of communication and social behavior. JA response, family resources, and group interacted to predict outcomes. Children with inflicted TBI who were less socially responsive and had lower levels of family resources had the least favorable outcomes. Low social responsiveness after TBI may be an early marker for later cognitive and adaptive behavior difficulties.

  4. Social Interaction in Young Children with Inflicted and Accidental Traumatic Brain Injury: Relations with Family Resources and Social Outcomes

    PubMed Central

    Ewing-Cobbs, Linda; Prasad, Mary R.; Mendez, Donna; Barnes, Marcia A.; Swank, Paul

    2016-01-01

    Core social interaction behaviors were examined in young children 0–36 months of age who were hospitalized for accidental (n = 61) or inflicted (n = 64) traumatic brain injury (TBI) in comparison to typically developing children (n = 60). Responding to and initiating gaze and joint attention (JA) were evaluated during a semi-structured sequence of social interactions between the child and an examiner at 2 and 12 months after injury. The accidental TBI group established gaze less often and had an initial deficit initiating JA that resolved by the follow-up. Contrary to expectation, children with inflicted TBI did not have lower rates of social engagement than other groups. Responding to JA was more strongly related than initiating JA to measures of injury severity and to later cognitive and social outcomes. Compared to complicated-mild/moderate TBI, severe TBI in young children was associated with less responsiveness in social interactions and less favorable caregiver ratings of communication and social behavior. JA response, family resources, and group interacted to predict outcomes. Children with inflicted TBI who were less socially responsive and had lower levels of family resources had the least favorable outcomes. Low social responsiveness after TBI may be an early marker for later cognitive and adaptive behavior difficulties. PMID:23507345

  5. Effect of a multi-level education intervention model on knowledge and attitudes of accidental injuries in rural children in Zunyi, Southwest China.

    PubMed

    Cao, Bo-Ling; Shi, Xiu-Quan; Qi, Yong-Hong; Hui, Ya; Yang, Hua-Jun; Shi, Shang-Peng; Luo, Li-Rong; Zhang, Hong; Wang, Xin; Yang, Ying-Ping

    2015-04-08

    To explore the effect of a school-family-individual (SFI) multi-level education intervention model on knowledge and attitudes about accidental injuries among school-aged children to improve injury prevention strategies and reduce the incidence of pediatric injuries. The random sample of rural school-aged children were recruited by using a multistage, stratified, cluster sampling method in Zunyi, Southwest China from 2012 to 2014, and 2342 children were randomly divided into intervention and control groups. Then children answered a baseline survey to collect knowledge and attitude scores (KAS) of accidental injuries. In the intervention group, children, their parents/guardians and the school received a SFI multi-level education intervention, which included a children's injury-prevention poster at schools, an open letter about security instruction for parents/guardians and multiple-media health education (Microsoft PowerPoint lectures, videos, handbooks, etc.) to children. Children in the control group were given only handbook education. After 16 months, children answered a follow-up survey to collect data on accidental injury types and accidental injury-related KAS for comparing the intervention and control groups and baseline and follow-up data. The distribution of gender was not significantly different while age was different between the baseline and follow-up survey. At baseline, the mean KAS was lower for the intervention than control group (15.37 ± 3.40 and 18.35 ± 5.01; p < 0.001). At follow-up, the mean KAS was higher for the intervention than control group (21.16 ± 3.05 and 20.02 ± 3.40; p < 0.001). The increase in KAS in the intervention and control groups was significant (p < 0.001; KAS: 5.79 vs. 1.67) and suggested that children's injury-related KAS improved in the intervention group. Moreover, the KAS between the groups differed for most subtypes of incidental injuries (based on International Classification of Diseases 10, ICD-10) (p < 0.05). Before

  6. Effect of a Multi-Level Education Intervention Model on Knowledge and Attitudes of Accidental Injuries in Rural Children in Zunyi, Southwest China

    PubMed Central

    Cao, Bo-Ling; Shi, Xiu-Quan; Qi, Yong-Hong; Hui, Ya; Yang, Hua-Jun; Shi, Shang-Peng; Luo, Li-Rong; Zhang, Hong; Wang, Xin; Yang, Ying-Ping

    2015-01-01

    Objective: To explore the effect of a school-family-individual (SFI) multi-level education intervention model on knowledge and attitudes about accidental injuries among school-aged children to improve injury prevention strategies and reduce the incidence of pediatric injuries. Methods: The random sample of rural school-aged children were recruited by using a multistage, stratified, cluster sampling method in Zunyi, Southwest China from 2012 to 2014, and 2342 children were randomly divided into intervention and control groups. Then children answered a baseline survey to collect knowledge and attitude scores (KAS) of accidental injuries. In the intervention group, children, their parents/guardians and the school received a SFI multi-level education intervention, which included a children’s injury-prevention poster at schools, an open letter about security instruction for parents/guardians and multiple-media health education (Microsoft PowerPoint lectures, videos, handbooks, etc.) to children. Children in the control group were given only handbook education. After 16 months, children answered a follow-up survey to collect data on accidental injury types and accidental injury-related KAS for comparing the intervention and control groups and baseline and follow-up data. Results: The distribution of gender was not significantly different while age was different between the baseline and follow-up survey. At baseline, the mean KAS was lower for the intervention than control group (15.37 ± 3.40 and 18.35 ± 5.01; p < 0.001). At follow-up, the mean KAS was higher for the intervention than control group (21.16 ± 3.05 and 20.02 ± 3.40; p < 0.001). The increase in KAS in the intervention and control groups was significant (p < 0.001; KAS: 5.79 vs. 1.67) and suggested that children’s injury-related KAS improved in the intervention group. Moreover, the KAS between the groups differed for most subtypes of incidental injuries (based on International Classification of

  7. Risk factors for recurrent injuries in victims of suspected non-accidental trauma: a retrospective cohort study.

    PubMed

    Deans, Katherine J; Thackeray, Jonathan; Groner, Jonathan I; Cooper, Jennifer N; Minneci, Peter C

    2014-08-31

    Many children who are victims of non-accidental trauma (NAT) may be repeatedly evaluated for injuries related to maltreatment. The purpose of this study was to identify risk factors for repeated injuries in children with suspected NAT. We conducted a retrospective cohort study using claims data from a pediatric Medicaid accountable care organization. Children with birth claims and at least one non-birth related claim indicating a diagnosis of NAT or skeletal survey in 2007-2011 were included. Recurrent events were defined as independent episodes of care involving an urgent/emergent care setting that included a diagnosis code specific for child abuse, a CPT code for a skeletal survey, or a diagnosis code for an injury suspicious for abuse. Cox proportional hazards models were used to examine risk factors for recurrent events. Of the 1,361 children with suspected NAT, a recurrent NAT event occurred in 26% within 1 year and 40% within 2 years of their initial event. Independent risk factors for a recurrent NAT event included a rural residence, age < 30 months old, having only 1 or 2 initially detected injuries, and having a dislocation, open wound, or superficial injury at the previous event (p ≤ 0.01 for all). Over 25% of children who experienced a suspected NAT event had a recurrent episode within one year. These children were younger and more likely to present with "minor" injuries at their previous event.

  8. Optimisation of the digital radiographic imaging of suspected non-accidental injury

    NASA Astrophysics Data System (ADS)

    Offiah, Amaka

    Aim: To optimise the digital (radiographic) imaging of children presenting with suspected non-accidental injury (NAI). Objectives: (i) To evaluate existing radiographic quality criteria, and to develop a more suitable system if these are found to be inapplicable to skeletal surveys obtained in suspected NAI. (ii) To document differences in image quality between conventional film-screen and the recently installed Fuji5000R computed radiography (CR) system at Great Ormond Street Hospital for Children, (iii) To document the extent of variability in the standard of skeletal surveys obtained in the UK for suspected NAI. (iv) To determine those radiographic parameters which yield the highest diagnostic accuracy, while still maintaining acceptable radiation dose to the child, (v) To determine how varying degrees of edge-enhancement affect diagnostic accuracy. (vi) To establish the accuracy of soft compared to hard copy interpretation of images in suspected NAI. Materials and Methods: (i) and (ii) Retrospective analysis of 286 paediatric lateral spine radiographs by two observers based on the Commission of European Communities (CEC) quality criteria, (iii) Review of the skeletal surveys of 50 consecutive infants referred from hospitals throughout the United Kingdom (UK) with suspected NAI. (iv) Phantom studies. Leeds TO. 10 and TO. 16 test objects were used to compare the relationship between film density, exposure parameters and visualisation of object details, (iv) Clinical study. Anteroposterior and lateral post mortem skull radiographs of six consecutive infants were obtained at various exposures. Six observers independently scored the images based on visualisation of five criteria, (v) and (vi) A study of diagnostic accuracy in which six observers independently interpreted 50 radiographs from printed copies (with varying degrees of edge-enhancement) and from a monitor. Results: The CEC criteria are useful for optimisation of imaging parameters and allow the detection

  9. Accidental inhalation injury of phosgene gas leading to acute respiratory distress syndrome

    PubMed Central

    Kumar, Anand; Chaudhari, Sudhir; Kush, Luv; Kumar, Suraj; Garg, Atul; Shukla, Anurag

    2012-01-01

    Irritant gas exposure may lead to significant respiratory distress as is seen in the present case of 25 year old male worker who suffered accidental phosgene inhalation. He remained asymptomatic for six hours but later landed up in Acute Respiratory Distress Syndrome in the hospital and required ventilatory support. No investigative feature is diagnostic of the nature of irritant gas. Similarly there is no antidote available to the phosgene. Only timely administered supportive management may lead to successful outcome. PMID:23580841

  10. Risk factors for recurrent injuries in victims of suspected non-accidental trauma: a retrospective cohort study

    PubMed Central

    2014-01-01

    Background Many children who are victims of non-accidental trauma (NAT) may be repeatedly evaluated for injuries related to maltreatment. The purpose of this study was to identify risk factors for repeated injuries in children with suspected NAT. Methods We conducted a retrospective cohort study using claims data from a pediatric Medicaid accountable care organization. Children with birth claims and at least one non-birth related claim indicating a diagnosis of NAT or skeletal survey in 2007–2011 were included. Recurrent events were defined as independent episodes of care involving an urgent/emergent care setting that included a diagnosis code specific for child abuse, a CPT code for a skeletal survey, or a diagnosis code for an injury suspicious for abuse. Cox proportional hazards models were used to examine risk factors for recurrent events. Results Of the 1,361 children with suspected NAT, a recurrent NAT event occurred in 26% within 1 year and 40% within 2 years of their initial event. Independent risk factors for a recurrent NAT event included a rural residence, age < 30 months old, having only 1 or 2 initially detected injuries, and having a dislocation, open wound, or superficial injury at the previous event (p ≤ 0.01 for all). Conclusions Over 25% of children who experienced a suspected NAT event had a recurrent episode within one year. These children were younger and more likely to present with “minor” injuries at their previous event. PMID:25174531

  11. ACCIDENTAL INJURIES TO WOMEN—Obstetrical and Gynecological Problems Associated with Damage Claims

    PubMed Central

    McNeil, Robert J.

    1955-01-01

    Women who have been injured should be examined for possible gynecological injury within 24 hours of the accident. Injuries to pregnant women do not usually cause an obstetrical crisis. When such an event does occur, there is positive evidence which relates it to the accident if there was such relationship. Metrorrhagia and menorrhagia are common sequelae of physical and psychological injury, but they are of temporary nature in cases in which there is no demonstrable pathologic change upon pelvic examination. Uterine prolapse, cystocele and rectocele are not caused by a single injury except in extremely rare instances. When vaginal vault injury has occurred as a result of a single injury, there is plentiful evidence of severe tissue damage. PMID:14390007

  12. Accidental Injuries among Children in Day Care Centers and Family Day Care Homes.

    ERIC Educational Resources Information Center

    Snow, Charles W.; And Others

    For this study, information was obtained about accidential injuries among children in day care centers (DCC) and family day care homes (DCH) in North Carolina. An Accident Survey Questionnaire was used to report injuries that required treatment by a staff member, doctor, or nurse. Results of data analyses showed that: (1) falls were the leading…

  13. Factors affecting the plasma insulin concentration shortly after accidental injury in man.

    PubMed Central

    Frayn, K N; Maycock, P F; Little, R A; Yates, D W; Stoner, H B

    1987-01-01

    There are conflicting reports on plasma insulin concentrations in the acutely injured. Plasma insulin and glucose concentrations have been measured in 504 patients within 8 h of injury, and related to the severity of injury as assessed by the injury severity score (ISS). As in previous surveys of injured patients, an extremely wide range of insulin concentrations was found (2-141 mU/l). Most of the variability occurred at lower severities of injury. In very severely injured patients (ISS greater than or equal to 30), insulin concentrations were uniformly suppressed (less than 20 mU/l), especially in relation to the hyperglycaemia in these patients. Two small subgroups, patients dying within 3 h of injury and known psychiatric patients on psycho-active drugs, differed from the general pattern in displaying elevated insulin concentrations despite very severe injuries. The results bear out the idea that insulin secretion is usually acutely suppressed by adrenaline after severe injury; after less severe injuries, however, the response is much less uniform. PMID:3304325

  14. Non-accidental injuries found in necropsies of domestic cats: a review of 191 cases.

    PubMed

    de Siqueira, Adriana; Cassiano, Fabiana Cecília; de Albuquerque Landi, Marina Frota; Marlet, Elza Fernandes; Maiorka, Paulo César

    2012-10-01

    Animal cruelty is defined as a deliberate action that causes pain and suffering to an animal. In Brazil, legislation known as the Environmental Crimes Law states that cruelty toward all animal species is criminal in nature. From 644 domestic cats necropsied between January 1998 and December 2009, 191 (29.66%) presented lesions highly suggestive of animal cruelty. The main necroscopic finding was exogenous carbamate poisoning (75.39%) followed by blunt-force trauma (21.99%). Cats from 7 months to 2 years of age were the most affected (50.79%). In Brazil, violence is a public health problem and there is a high prevalence of domestic violence. Therefore, even if laws provide for animal welfare and protection, animals are common targets for violent acts. Within a context of social violence, cruelty toward animals is an important parameter to be considered, and the non-accidental lesions that were found are evidence of malicious actions.

  15. Accidental injury of the inferior alveolar nerve due to the extrusion of calcium hydroxide in endodontic treatment: a case report

    PubMed Central

    2016-01-01

    During clinical endodontic treatment, we often find radiopaque filling material beyond the root apex. Accidental extrusion of calcium hydroxide could cause the injury of inferior alveolar nerve, such as paresthesia or continuous inflammatory response. This case report presents the extrusion of calcium hydroxide and treatment procedures including surgical intervention. A 48 yr old female patient experienced Calcipex II extrusion in to the inferior alveolar canal on left mandibular area during endodontic treatment. After completion of endodontic treatment on left mandibular first molar, surgical intervention was planned under general anesthesia. After cortical bone osteotomy and debridement, neuroma resection and neurorrhaphy was performed, and prognosis was observed. But no improvement in sensory nerve was seen following surgical intervention after 20 mon. A clinician should be aware of extrusion of intracanal medicaments and the possibility of damage on inferior alveolar canal. Injectable type of calcium hydroxide should be applied with care for preventing nerve injury. The alternative delivery method such as lentulo spiral was suggested on the posterior mandibular molar. PMID:26877992

  16. Accidental injury of the inferior alveolar nerve due to the extrusion of calcium hydroxide in endodontic treatment: a case report.

    PubMed

    Shin, Yooseok; Roh, Byoung-Duck; Kim, Yemi; Kim, Taehyeon; Kim, Hyungjun

    2016-02-01

    During clinical endodontic treatment, we often find radiopaque filling material beyond the root apex. Accidental extrusion of calcium hydroxide could cause the injury of inferior alveolar nerve, such as paresthesia or continuous inflammatory response. This case report presents the extrusion of calcium hydroxide and treatment procedures including surgical intervention. A 48 yr old female patient experienced Calcipex II extrusion in to the inferior alveolar canal on left mandibular area during endodontic treatment. After completion of endodontic treatment on left mandibular first molar, surgical intervention was planned under general anesthesia. After cortical bone osteotomy and debridement, neuroma resection and neurorrhaphy was performed, and prognosis was observed. But no improvement in sensory nerve was seen following surgical intervention after 20 mon. A clinician should be aware of extrusion of intracanal medicaments and the possibility of damage on inferior alveolar canal. Injectable type of calcium hydroxide should be applied with care for preventing nerve injury. The alternative delivery method such as lentulo spiral was suggested on the posterior mandibular molar.

  17. Pattern and distribution of pedestrian injuries in fatal road traffic accidental cases in Dharan, Nepal.

    PubMed

    Mandal, Birendra Kumar; Yadav, Biswa Nath

    2014-07-01

    Road traffic injuries are one of the leading causes of death in the world. The present study aims at evaluation of pattern and distribution of injuries among pedestrians thereby planning successful measures to minimize fatalities. The present study was conducted in the Department of Forensic Medicine and Toxicology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal. This study included 50 cases of pedestrian victims of fatal road traffic accident, brought for medico-legal postmortem examination. Highest number (17 or 21.3%) of fatalities occurred in the 41-50 years age group followed by the age group 31-40 years (15 or 18.7%). Male victims outnumbered female resulting in male to female ratio of 1.8:1. Most of the pedestrians were illiterate (26 or 32.5%) followed by those who were educated up to primary school (14 or 17.5%). Nearly half of the cases (38 or 47.5%), four or more wheelers - heavy vehicles - were involved. Fracture was the most common type of injuries (55 or 28.9%) followed by laceration (50 or 26.3%). In 44 (55%) cases, primary impact injuries were noted, secondary impact injuries in 55 (68.7%) cases, and secondary injuries in 62 (77.5%) cases. More than one-fourth (22 or 27.5%) of the deaths were due to pelvic and extremities injuries. Pedestrians, people who travel by foot, wheelchair, stroller, or similar means, are most vulnerable users of the road. Before head out on foot for a stroll, power walk, or errand, there are important safety tips to remember. A greater awareness about traffic rules will go a long way in curbing the incidence of fatal pedestrian accidents.

  18. Severe esophageal injuries caused by accidental button battery ingestion in children.

    PubMed

    Fuentes, Sara; Cano, Indalecio; Benavent, María Isabel; Gómez, Andrés

    2014-10-01

    Button batteries represent a low percentage of all foreign bodies swallowed by children and esophageal location is even less frequent. However, these cases are more likely to develop severe injuries. The aim of this essay is to report three cases treated in our institution and review previous reports. Chart review and literature search. We treated three children between 2-7- years old with button batteries lodged at esophagus. They all presented esophageal burns (EB), which evolved in esophageal stenosis in two out of the three cases. We found 29 more cases in literature and the injuries included EB, esophageal perforation (EP) and tracheoesophageal fistula (TEF). Swallowed button batteries rarely remain in esophagus, but these cases present a higher risk of tisular damage. Injuries can take place even after few hours; and therefore, endoscopy must be performed as soon as possible. Further study on button batteries' safety and the establishment of a maximum size for them would be good preventive measures.

  19. Accidental Peno-Scrotal Degloving Injuries in a Child. A Case Report and Literature Review.

    PubMed

    Oseni, O G; Olaitan, P B; Badmus, T O; Olajide, A O

    2013-01-01

    Injury to male external genitalia is very rare because of some intrinsic factors like location, strong investing tunica albuginea and cremasteric muscles. However, when it occurs it is considered a urological emergency. Child labour with poor understanding of risks and safety precautions, especially under harsh supervision, surely poses major challenges. This case illustrates degloving injury of the penis and avulsion of the scrotum in a young boy while operating a roller type machine used in palm trees plantation. The penis was primarily regloved and avulsed skin primarily repaired. A good cosmetic outcome was observed from this treatment. This case also illustrates the importance of early presentation and emergency intervention in this condition.

  20. Simple battery armor to protect against gastrointestinal injury from accidental ingestion.

    PubMed

    Laulicht, Bryan; Traverso, Giovanni; Deshpande, Vikram; Langer, Robert; Karp, Jeffrey M

    2014-11-18

    Inadvertent battery ingestion in children and the associated morbidity and mortality results in thousands of emergency room visits every year. Given the risk for serious electrochemical burns within hours of ingestion, the current standard of care for the treatment of batteries in the esophagus is emergent endoscopic removal. Safety standards now regulate locked battery compartments in toys, which have resulted in a modest reduction in inadvertent battery ingestion; specifically, 3,461 ingestions were reported in 2009, and 3,366 in 2013. Aside from legislation, minimal technological development has taken place at the level of the battery to limit injury. We have constructed a waterproof, pressure-sensitive coating, harnessing a commercially available quantum tunneling composite. Quantum tunneling composite coated (QTCC) batteries are nonconductive in the low-pressure gastrointestinal environment yet conduct within the higher pressure of standard battery housings. Importantly, this coating technology enables most battery-operated equipment to be powered without modification. If these new batteries are swallowed, they limit the external electrolytic currents responsible for tissue injury. We demonstrate in a large-animal model a significant decrease in tissue injury with QTCC batteries compared with uncoated control batteries. In summary, here we describe a facile approach to increasing the safety of batteries by minimizing the risk for electrochemical burn if the batteries are inadvertently ingested, without the need for modification of most battery-powered devices.

  1. Simple battery armor to protect against gastrointestinal injury from accidental ingestion

    PubMed Central

    Laulicht, Bryan; Deshpande, Vikram; Langer, Robert; Karp, Jeffrey M.

    2014-01-01

    Inadvertent battery ingestion in children and the associated morbidity and mortality results in thousands of emergency room visits every year. Given the risk for serious electrochemical burns within hours of ingestion, the current standard of care for the treatment of batteries in the esophagus is emergent endoscopic removal. Safety standards now regulate locked battery compartments in toys, which have resulted in a modest reduction in inadvertent battery ingestion; specifically, 3,461 ingestions were reported in 2009, and 3,366 in 2013. Aside from legislation, minimal technological development has taken place at the level of the battery to limit injury. We have constructed a waterproof, pressure-sensitive coating, harnessing a commercially available quantum tunneling composite. Quantum tunneling composite coated (QTCC) batteries are nonconductive in the low-pressure gastrointestinal environment yet conduct within the higher pressure of standard battery housings. Importantly, this coating technology enables most battery-operated equipment to be powered without modification. If these new batteries are swallowed, they limit the external electrolytic currents responsible for tissue injury. We demonstrate in a large-animal model a significant decrease in tissue injury with QTCC batteries compared with uncoated control batteries. In summary, here we describe a facile approach to increasing the safety of batteries by minimizing the risk for electrochemical burn if the batteries are inadvertently ingested, without the need for modification of most battery-powered devices. PMID:25368176

  2. Factors Related to Acute Anxiety and Depression in Inpatients with Accidental Orthopedic Injuries

    PubMed Central

    WU, Hui; ZHANG, Fang; CHENG, Wenhong; LIN, Ying; WANG, Qian

    2017-01-01

    Background Those injured in accidents commonly have strong emotional reactions to their situation. However, despite the large number of patients who are admitted to general hospitals each year for orthopedic injuries due to an accident, research focusing on psychological disorders due to these injuries is lacking. Objective To investigate the presentation and factors related to depression and acute anxiety among inpatients being treated for injury on a Trauma Orthopedics Unit. Methods 323 patients with orthopedic trauma were evaluated using the Injury Severity Score (ISS), Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD). Results In this study, a total of 323 inpatients (213 males and 110 females) had a mean (sd) age of 44.3 (13.2) years old. Mean (sd) time in the hospital was 11.1 (5.7) days with a range of 2 to 40 days. Among these patients, 299 had mild trauma, 20 had moderate trauma, and 4 had severe trauma. Patients had a mean (sd) score of 8.1 (4.9) with a range of 1 to 38. The top three most reported symptoms from the HAMA were sleep disorder, gastrointestinal symptoms and anxiety. The top three most reported symptoms from the HAMD were sleep disorder, depression and anxiety. Non-conditional logistic regression analysis showed that being female (anxiety: OR=2.738, 95%CI=1.511-4.962; depression: OR=2.622, 95%CI=1.504-4.570) and duration of hospitalization (anxiety: OR=1.091, 95%CI=1.040-1.145; depression: OR=1.093, 95%CI=1.044-1.144) were risk factors for anxiety and depression among these orthopedic trauma patients. Conclusion The main acute symptoms of anxiety and depression in these orthopedic trauma inpatients were sleep disorder, gastrointestinal symptoms, anxious mood and depressed mood. Female patients had stronger emotional reactions to injuries than males. Persistent anxiety and depression symptoms were associated with the duration of hospitalization. All these suggest the need for early psychological assessment and intervention for

  3. Posttraumatic growth within the first three months after accidental injury in China: the role of self-disclosure, cognitive processing, and psychosocial resources.

    PubMed

    Dong, Chaoqun; Gong, Shumei; Jiang, Liping; Deng, Guanghui; Liu, Xiaohong

    2015-01-01

    The primary goals of this study, were to identify the posttraumatic growth (PTG) level of accidentally injured Chinese patients shortly after an accident occurred and to determine whether cognitive processing, self-disclosure, and psychosocial resources predicted PTG. A total of 232 patients were recruited from two public hospitals in Shanghai within the first three months of an accidental injury. Patients completed self-report questionnaires to assess severity of injury, cognitive processing, self-disclosure, psychosocial resources, and PTG. Patients reported a mid-low level of PTG (M = 50.38, SD = 18.12) in the short length of time post-injury. Hierarchical regression analysis indicated that subjective accident severity, deliberate rumination, perceived social support, and attitude towards disclosure were strong predictors of PTG. A moderating role of self-disclosure between intrusive rumination and PTG was identified. These findings support an interaction effect of rumination and self-disclosure on PTG and have implications for early intervention of accidentally injured patients.

  4. Accidental head explosion: an unusual blast wave injury as a result of self-made fireworks.

    PubMed

    Kunz, S N; Zinka, B; Peschel, O; Fieseler, S

    2011-07-15

    A 33-year old hobby pyrotechnician sustained a lethal craniofacial trauma secondary to a salute fireworks blast. He was examining a misfire of a self-constructed salute gun, when it detonated, causing an explosively rupture of his forehead, which led to his immediate death. An autopsy was performed to achieve knowledge of the injury and to be able to reconstruct the events that lead to it. The pressure effect of the explosion caused a shredded rupture of the forehead with a regional spread of brain tissue and small polygonal skull fragments up to 30m from the detonation site. Furthermore multiple cinderlike fragments of black powder were embedded in the skin of the face and the anterior aspect of the neck (s.c. blast tattoo). The complete destruction of the forehead in combination with the multiple blast tattooing suggested that the explosion detonated while he was leaning over the device.

  5. Subdural hematoma in infants without accidental or nonaccidental injury: benign external hydrocephalus, a risk factor.

    PubMed

    Ghosh, Partha S; Ghosh, Debabrata

    2011-10-01

    Benign external hydrocephalus (BEH) is considered a self-limiting condition in infants. Subdural hematoma (SDH) in infants without a history of trauma indicates nonaccidental injury (NAI). The authors studied whether SDH can complicate BEH without apparent trauma. Out of 45 children younger than 3 years with nontraumatic SDH, 9 (7 boys) with mean age 6 months had BEH as risk factor. Symptoms included increasing head size (8), fussiness, and irritability (3). Three had up-gaze restriction, 1 axial hypotonia, and 6 normal examination. Neuroimaging showed prominent extra-axial spaces; SDH was bilateral (6), subacute (5). Other etiological workup for SDH was negative except NAI in 1. Two required evacuation of SDH and subdural-peritoneal shunt; others managed conservatively. Development was normal in 8 on follow-up. On follow-up imaging of 8, SDH completely resolved in 3, markedly reduced in 3, and remained stable in 2. BEH is a risk factor for SDH in infants, thus not always benign.

  6. Feasibility of a screening program for at-risk children following accidental injury.

    PubMed

    March, Sonja; Kenardy, Justin A; Cobham, Vanessa E; Nixon, Reginald D V; McDermott, Brett; De Young, Alexandra

    2015-02-01

    Screening is recommended as a simple method for identifying those who should be monitored for risk following trauma. Effective methods for implementing large-scale screening programs are yet to be established. This study tested the feasibility and utility of a screening program with hospitalized youth exposed to injury in 3 Australian hospitals. Eligible families (N = 1,134) were contacted and 546 children (48.0%) screened for risk of posttraumatic stress disorder (PTSD) at 1-2 weeks postinjury. There were 95 (17.4%) children whose screen result was at risk. A rescreening phase was introduced during the study, with 68 children completing the rescreen at 4-6 weeks postinjury, and 26 (38.2% of those rescreened) still at risk. Of those initially screened, 29 (5.3%) completed diagnostic assessments, 21 (3.8%) were diagnosed with partial or full PTSD, and 17 (3.1%) commenced treatment. Screening was successful at identifying and reaching children with PTSD, but the response rate was lower than expected, which limited the utility of the program. The addition of a rescreening phase demonstrated that not all at-risk children required intervention. These findings replicate previous studies that have shown natural remission in PTSD symptoms and highlight the potential for rescreening as part of a watchful waiting approach. Copyright © 2015 International Society for Traumatic Stress Studies.

  7. Accidental renal injury by an external heating device during surgery in rats.

    PubMed

    Roehl, A B; Teubner, A; Funcke, S; Goetzenich, A; Rossaint, R; Tolba, R; Hein, M

    2011-01-01

    Hypothermia can be caused by anaesthesia and/or surgery and represents a daily challenge in the operating room. Experimental animal surgery settings typically use heating pads or warming blankets to maintain the rodent's body temperature during long-lasting experiments. Warming is crucial in small animal experiments because these animals quickly lose temperature due to their large body surface to body weight ratio. While establishing a left ventricular infarction model in rats, we inserted a rectal temperature probe. The heating pad's set point was 37°C. Although a dual set point control circuit should prevent overheating, we observed a maximum heating pad's surface temperature of 43°C between the animal's back and the surface of the heating pad. At the end of the experiments, which lasted up to 8 h, the animals showed severe haematuria and segmental kidney damage. We hypothesized that overheating of the heating pad and uneven distribution of temperature led to kidney damage. Therefore, the maximal temperature of commonly used heating pads must be tightly controlled to avoid overheating, which may cause kidney or tissue injury, may falsify the experimental data and could influence the study results.

  8. Human color vision deficits induced by accidental laser exposure and potential for long-term recovery

    NASA Astrophysics Data System (ADS)

    Zwick, Harry; Lund, Brian J.; Brown, Jeremiah, Jr.; Stuck, Bruce E.; Loveday, J.

    2003-06-01

    Purpose: To evaluate long term deficits in human color discrimination induced by accidental laser macular damage and assess potential for recovery of color vision deficits. Methods: Nine laser accident cases (Q-switched Neodymium) presenting initially with confined or vitreous macular hemorrhage were evaluated with the Farnsworth-Munsell 100 Hue test within 2 days to 3 months post exposure. Both total as well as partial errors in the blue/yellow (B/Y) and red/green (R/G) regions were assessed. Independent assessment of axis orientation and complexity were obtained via a Fourier series expansion of error scores. Comparisons of both total and partial B/Y and R/G errors were made with age matched normal subjects, idiopathic and juvenile onset macular holes. Confocal Scanning Laser Ophthalmoscopy and Optical Coherence Tomography characterized the presence of retinal traction, intraretinal scar, macular thickness and macular hole formation. Results: Comparison of exposed and non-exposed age matched individuals were significant (P<.001) for both total and partial errors. In four cases where macular injury ranged from mild scar to macular hole, color discrimination errors achieved normal levels in 1 to 12 months post exposure. A mild tritan axis, dominant B/Y ("blue/yellow") errors, and retinal traction were observed in a macular hole case. At 12 months post exposure, traction about the hole disappeared, and total and partial errors were normal. Where damage involved a greater degree of scarring, retinal traction and multiple injury sites, long term recovery of total and partial error recovery was retarded with complex axis makeup. Single exposures in the paramacula produced tritan axes, while multiple exposures within and external to the macula increased total and partial R/G ("red/green") error scores. Total errors increased when paramacular hole enlargement induced macular traction. Such hole formation produced significant increases in total errors, complex axis

  9. Accidental explosions

    SciTech Connect

    Medard, L.A.

    1989-01-01

    This book presents a survey of accidental explosions, their nature and their causes. It covers the physical and chemical conditions governing accidental explosions, whether in the gas phase, or in the liquid or solid state. The theoretical background of the kinetics and thermochemistry of explosions is outlined, followed by a detailed study of the explosion and detonation properties of both gas and condensed explosives. The author surveys a wide variety of substances in daily use in industry which can give rise to accidental explosions. Their properties and hazards are spelt out in detail, the discussion drawing on a long history of sometimes catastrophic accidents. Includes case studies, tables of physical and chemical data.

  10. Protocol for a randomised controlled trial of risk screening and early intervention comparing child- and family-focused cognitive-behavioural therapy for PTSD in children following accidental injury.

    PubMed

    Kenardy, Justin; Cobham, Vanessa; Nixon, Reginald D V; McDermott, Brett; March, Sonja

    2010-11-16

    Accidental injury represents the most common type of traumatic event to which a child or adolescent may be exposed, with a significant number of these children going on to experience posttraumatic stress disorder (PTSD). However, very little research has examined potential interventions for the treatment of PTSD in these children. The present trial aims to evaluate and compare child- and family-focused versions of a cognitive-behavioural early intervention for PTSD following accidental injury. The principal clinical question under investigation is the efficacy of an early, trauma-focused cognitive-behavioural intervention for the treatment of PTSD in children following accidental injury. Specifically, we compare the efficacy of two active treatments (child-focused and family-focused CBT) and a waitlist control (no therapy) to determine which is associated with greater reductions in psychological and health-related outcome measures over time. The primary outcome will be a reduction in trauma symptoms on a diagnostic interview in the active treatments compared to the waitlist control and greater reductions in the family-compared to the child-focused condition. In doing so, this project will also trial a method of stepped screening and assessment to determine those children requiring early intervention for PTSD following accidental injury. The present trial will be one of the first controlled trials to examine a trauma-focused CBT, early intervention for children experiencing PTSD following accidental injury (as opposed to other types of traumatic events) and the first within a stepped care approach. In addition, it will provide the first evidence comparing the efficacy of child and family-focused interventions for this target group. Given the significant number of children and adolescents exposed to accidental injury, the successful implementation of this protocol has considerable implications. If efficacious, this early intervention will assist in reducing symptoms

  11. Use of specific immunoglobulins and vaccines for the management of accidental needlestick injury in the child: a practical review in the anti-vaccination movement era.

    PubMed

    Sollai, Sara; Iacopelli, Jessica; Giovannini, Mattia; Prato, Manuela; Galli, Luisa; de Martino, Maurizio; Chiappini, Elena

    2016-10-01

    Accidental needle injury is a common but still discussed problem. We discuss possible options to optimize the management of injured children in light of the available literature findings. The risk of viral infection is low. However, blood investigations are mandatory, as well as appropriate counselling. Anti-HBV immunoglobulins are recommended in all unvaccinated subjects exposed to a HBsAg-positive source; however, there is no agreement regarding their administration in unvaccinated children. Use of anti-tetanus immunoglobulins in unvaccinated child with minor and clean wound is well defined; however, wound type classification in the event of needlestick injury may be difficult and subjective. There is no agreement on the routine use of antiretroviral prophylaxis. From a practical point of view, several unsolved issues have emerged regarding the management of the children with needlestick injury, which appear particularly relevant in the anti-vaccination movement era. International guidelines should be encouraged at this regard.

  12. Macular degeneration

    MedlinePlus Videos and Cool Tools

    ... at the center of the field of vision. Macular degeneration results from a partial breakdown of the insulating ... choroid layer of blood vessels behind the retina. Macular degeneration results in the loss of central vision only.

  13. Diffuse neuronal perikaryal amyloid precursor protein immunoreactivity in an ovine model of non-accidental head injury (the shaken baby syndrome).

    PubMed

    Finnie, John W; Manavis, Jim; Blumbergs, Peter C

    2010-02-01

    Non-accidental head injury ("shaken baby syndrome") is a major cause of death and disability in infants and young children, but it is uncertain whether shaking alone is sufficient to cause brain damage or an additional head impact is required. Accordingly, we used manual shaking in an ovine model in an attempt to answer this question since lambs have a relatively large gyrencephalic brain and weak neck muscles resembling a human infant. Neuronal perikaryal and axonal reactions were quantified 6 hours after shaking using amyloid precursor protein (APP) immunohistochemistry. Neuronal perikaryal APP was widely distributed in the brain and spinal cord, the first time such a diffuse neuronal stress response after shaking has been demonstrated, but axonal immunoreactivity was minimal and largely confined to the rostral cervical spinal cord at the site of maximal loading. No ischaemic-hypoxic damage was found in haematoxylin and eosin-stained sections.

  14. Protocol for a randomised controlled trial of risk screening and early intervention comparing child- and family-focused cognitive-behavioural therapy for PTSD in children following accidental injury

    PubMed Central

    2010-01-01

    Background Accidental injury represents the most common type of traumatic event to which a child or adolescent may be exposed, with a significant number of these children going on to experience posttraumatic stress disorder (PTSD). However, very little research has examined potential interventions for the treatment of PTSD in these children. The present trial aims to evaluate and compare child- and family-focused versions of a cognitive-behavioural early intervention for PTSD following accidental injury. Methods/Design The principal clinical question under investigation is the efficacy of an early, trauma-focused cognitive-behavioural intervention for the treatment of PTSD in children following accidental injury. Specifically, we compare the efficacy of two active treatments (child-focused and family-focused CBT) and a waitlist control (no therapy) to determine which is associated with greater reductions in psychological and health-related outcome measures over time. The primary outcome will be a reduction in trauma symptoms on a diagnostic interview in the active treatments compared to the waitlist control and greater reductions in the family-compared to the child-focused condition. In doing so, this project will also trial a method of stepped screening and assessment to determine those children requiring early intervention for PTSD following accidental injury. Discussion The present trial will be one of the first controlled trials to examine a trauma-focused CBT, early intervention for children experiencing PTSD following accidental injury (as opposed to other types of traumatic events) and the first within a stepped care approach. In addition, it will provide the first evidence comparing the efficacy of child and family-focused interventions for this target group. Given the significant number of children and adolescents exposed to accidental injury, the successful implementation of this protocol has considerable implications. If efficacious, this early

  15. Bilateral macular cysts following electric burn.

    PubMed

    Sony, Parul; Venkatesh, Pradeep; Tewari, Hem Kumar; Garg, Sat Pal

    2005-02-01

    A 28-year-old man presented with bilateral acute loss of vision following a high-voltage injury. The visual acuity was 6/36 in the right eye and 6/24 in the left eye. Fundus examination revealed a well-defined round lesion simulating a full thickness macular hole in the right eye and yellow deposits in the macular area in the left eye. Optical coherence tomography (OCT) showed bilateral macular cysts, with intact outer and inner retinal layers. At 1 month follow up, OCT showed a persistent macular cyst in the right eye with spontaneous resolution of the macular cyst along with visual improvement in the left eye.

  16. Accidental injuries associated with nonhuman primate exposure at two regional primate research centers (USA): 1988-1993.

    PubMed

    bin Zakaria, M; Lerche, N W; Chomel, B B; Kass, P H

    1996-06-01

    Although occupationally acquired zoonoses of nonhuman primates have been well documented, the epidemiology of work-related injuries associated with occupational exposure to nonhuman primates has not been studied. To investigate such injuries, we retrospectively reviewed injury records at one regional primate research center and distributed a self-administered, anonymous questionnaire to at-risk personnel at two centers. Records of bite, animal-inflicted scratch, needlestick, cut, and mucous membrane exposure injuries were reviewed at one center for the 5-year period 1988 to 1993 to determine incidence and frequency of injuries and to identify possible risk factors. A total of 261 injuries were reported during this period, with an annual incidence for all injuries combined ranging from 43.5 to 65.5 injuries per 100,000 person workdays (pwd) at risk. For specific injuries the highest incidence was observed for animal-inflicted scratches and bites, with a rate of 82 and 81 per 100,000 pwd respectively. The job category Veterinary Resident was found to have the highest incidence for needlestick injuries (547 per 100,000 pwd), scratches (239 per 100,000 pwd), and cuts (171 per 100,000 pwd). The highest rates for bites were observed in the job categories Animal Health Technician and Animal Technician, with 171 and 150 per 100,000 pwd respectively; the category Staff Veterinarian had the highest rate of mucous membrane exposures (71 per 100,000 pwd). The frequency of all injuries was greatest in personnel employed < or = 2 years. Questionnaire responses indicated that having > 20 h per week of contact with nonhuman primates or contact with more than 50 nonhuman primates per week was associated with a significantly increased risk of bites, animal-inflicted scratches, needlesticks, and mucous membrane exposures. In addition, data analysis indicated that under-reporting of work-related injuries was high; 59% of scratches, 50% of mucous membrane exposures, 45% of cuts, 37% of

  17. [Accidental falls].

    PubMed

    Inokuchi, Koichi

    2013-06-01

    Falls are common cause of injuries among elderly people, and fractures are the most serious consequence of falls. For seniors, hip fractures are the second major cause of bedridden. The feature and acute care of head injury, spinal cord injury, vertebrae fracture, and hip fracture are described. Just had fracture fixation, the patient can not go back to the original ADL. In order not to become bedridden, both medication and physical examination are important based on the new disease concept of locomotive syndrome. To do so, requires hospital and clinic cooperation. Sufficient cooperation is not currently possible, and spread of liaison service is essential.

  18. [Macular dystrophies].

    PubMed

    Souied, E; Kaplan, J; Coscas, G; Soubrane, G

    2003-09-01

    Macular dystrophies are a group of hereditary disorders of the macula occurring in children or young adults. The most frequent in France will be presented in detail: Best disease, Stargardt macular dystrophy, cone dystrophy, X-linked retinoschisis, pattern dystrophy, and malattia leventinese. Molecular biology studies have now mapped and identified the genes involved in these macular dystrophies. Analysis of the features of fundus examination will lead to further examinations such as fluorescein angiography, indocyanine green angiography, optical coherent tomography, electroretinography, or electrooculography, in order to confirm the diagnosis. We will also present the differential diagnosis of each of these macular dystrophies.

  19. The Prevalence of Accidental Needle Stick Injury and their Reporting among Healthcare Workers in Orthopaedic Wards in General Hospital Melaka, Malaysia.

    PubMed

    Bhardwaj, A; Sivapathasundaram, N; Yusof, Mf; Minghat, Ah; Swe, Kmm; Sinha, Nk

    2014-07-01

    Background :Accidental needle-stick injuries (NSIs) are a hazard for health-care workers and general public health. Orthopaedic surgeons may be more prone to NSIs due to the prevalence of bone spikes in the operative field and the use of sharp orthopaedic instruments such as drills, saws and wires. A hospital-based cross sectional study was conducted in the orthopedic wards of Melaka General Hospital. The prevalence of NSIs was 32 (20.9%) and majority of it occurred during assisting in operation theatre 13(37.4%). Among them six (18.8%) were specialist, 12(37.5%) medical officer, 10 (31.2%) house officer and four staff nurses (12.5%). Among the respondents 142 (92.8%) had been immunized against Hepatitis B and 148 (96.7%) participants had knowledge regarding universal precaution. The incidence of NSI among health care workers at orthopaedics ward was not any higher in comparison with the similar studies and it was found out that the prevalence was more in junior doctors compared with specialist and staff nurses and it was statistically significant. Needle sticks injury, health care workers, and standard precaution.

  20. A Novel Restraint Device for Injection of Galleria mellonella Larvae that Minimizes the Risk of Accidental Operator Needle Stick Injury

    PubMed Central

    Dalton, James P.; Uy, Benedict; Swift, Simon; Wiles, Siouxsie

    2017-01-01

    Larvae of the insect Galleria mellonella are increasingly being used for studying pathogenic microbes and their virulence mechanisms, and as a rapid model for screening novel antimicrobial agents. The larvae (waxworms) are most frequently infected by injection of pathogenic organisms into the haemocoel through the insect's prolegs. The mostly widely used method for restraining the waxworms for injection is by grasping them between the operator's fingers, which puts the operator at risk of needle stick injury, an important consideration when working with highly pathogenic and/or drug-resistant microorganisms. While use of a stab proof glove can reduce this risk of injury, it does so at the loss of manual dexterity and speed, resulting in a more labor-intensive, and cumbersome assay. We describe a simple cost effective device (the so-called “Galleria Grabber”) for restraining waxworms for injection that keeps the operator's fingers clear of the needle thus reducing the risk of injury. PMID:28401069

  1. Prosthodontic Rehabilitation of Accidental Maxillofacial Gunshot Injury Using Dental Implants: A Five Year Follow-Up Clinical Report

    PubMed Central

    Balla, Vinod; Daniel, Angleena Y

    2016-01-01

    Gunshot injuries to the face can have serious aesthetic, functional, and psychological consequences. The incapacitating nature of maxillofacial defects makes reconstruction of the maxilla and mandible challenging, owing to multiple surgeries and extensive rehabilitation phase. Outcome of prosthodontic treatment is one of the important parameters by which a patient measures the success of rehabilitation. A 5-year follow-up of comprehensive surgical and prosthodontic reconstruction of a gunshot injury using dental implants is described. This case report illustrates the contribution of immediate dental implants with proper oral hygiene follow-up as an effective treatment modality in restoring a patient to near normal function and aesthetics. PMID:27790591

  2. [Mortality as a result of accidental and intentional injuries in the Federal District from 1970 to 1986].

    PubMed

    Híjar-Medina, M C

    1990-01-01

    This article presents the results of a retrospective analysis of unintentional and intentional injury mortality in México City for the period 1970-1986. The mortality rates and trends were obtained out of 73,197 registered deaths, (according to the 9th revision of the International Disease Classification). Deaths due to the earthquakes of 1985 were not included. The trend of mortality is undefined (r = -0.430). The most important causes of death were: traffic accidents, homicides, and others accidents. Males accounted 77 per cent of the deaths. The most affected age groups were 15-19 and 20-24 years. The potential years of life lost were analyzed. This study provides information for the prevention and control of injuries and for future research in this field.

  3. [Accident or maltreatment? Radiographic X‑ray patterns in non‑accidental trauma : The concept of sentinel injuries].

    PubMed

    Hirsch, F W; Sorge, I; Roth, C; Gosemann, J-H

    2016-05-01

    The focus of this review article is on child abuse and the radiographic pattern of X‑ray findings. The radiologist should be able to recognize typical injuries resulting from child abuse. In some cases the findings are highly specific for abuse and these include metaphyseal corner fractures of the long bones in children aged up to 24 months. In other cases the fractures are not specific but highly indicative of child abuse: rib fractures, for example can be associated with child abuse in more than 50 % of the cases; however, maltreatment is difficult to diagnose without taking the entire pattern of skeletal findings into consideration so that a radiological screening of the entire skeleton is often necessary. The concept of sentinel injuries might be helpful for deciding in which cases a complete skeletal screening should be performed. In the age group up to 24 months old a complete skeletal status (with some exceptions) is recommended if one of the three sentinel injuries of rib fractures, intracranial bleeding and abdominal trauma is present.

  4. When are burns not accidental?

    PubMed

    Hobbs, C J

    1986-04-01

    One hundred and ninety five children aged up to 6 years with burns and scalds (30 non-accidental and 165 accidental) were studied retrospectively. The history, presentation, and other typical injuries assisted the diagnosis of abuse. Scalds accounted for 81% of accidents and 25% of the cases of abuse, and burns for 17% and 44%, respectively. Scalds usually followed spillage from kitchen containers in accidents and forced tap water immersion in cases of abuse. Burns in cases of both accidents and abuse resulted from contact with a wide range of household appliances, including room heaters. Attention is drawn to the back of the hand as an important site in cases of abuse, as well as the legs, buttocks, and feet. It is speculated that the low level of reporting of this form of child abuse reflects failure of diagnosis.

  5. Dry Macular Degeneration

    MedlinePlus

    ... delay vision loss due to dry macular degeneration. Symptoms Dry macular degeneration symptoms usually develop gradually and without pain. They may ... of printed words Decreased intensity or brightness of ... causes total blindness. Dry macular degeneration is one of two types ...

  6. Macular degeneration (image)

    MedlinePlus

    Macular degeneration is a disease of the retina that affects the macula in the back of the eye. ... see fine details. There are two types of macular degeneration, dry and wet. Dry macular degeneration is more ...

  7. Predicting posttraumatic stress disorder in children and parents following accidental child injury: evaluation of the Screening Tool for Early Predictors of Posttraumatic Stress Disorder (STEPP).

    PubMed

    van Meijel, Els P M; Gigengack, Maj R; Verlinden, Eva; Opmeer, Brent C; Heij, Hugo A; Goslings, J Carel; Bloemers, Frank W; Luitse, Jan S K; Boer, Frits; Grootenhuis, Martha A; Lindauer, Ramón J L

    2015-05-12

    Children and their parents are at risk of posttraumatic stress disorder (PTSD) following injury due to pediatric accidental trauma. Screening could help predict those at greatest risk and provide an opportunity for monitoring so that early intervention may be provided. The purpose of this study was to evaluate the Screening Tool for Early Predictors of Posttraumatic Stress Disorder (STEPP) in a mixed-trauma sample in a non-English speaking country (the Netherlands). Children aged 8-18 and one of their parents were recruited in two academic level I trauma centers. The STEPP was assessed in 161 children (mean age 13.9 years) and 156 parents within one week of the accident. Three months later, clinical diagnoses and symptoms of PTSD were assessed in 147 children and 135 parents. We used the Anxiety Disorders Interview Schedule for DSM-IV - Child and Parent version, the Children's Revised Impact of Event Scale and the Impact of Event Scale-Revised. Receiver Operating Characteristic analyses were performed to estimate the Areas Under the Curve as a measure of performance and to determine the optimal cut-off score in our sample. Sensitivity, specificity, positive and negative predictive values were calculated. The aim was to maximize both sensitivity and negative predictive values. PTSD was diagnosed in 12% of the children; 10% of their parents scored above the cut-off point for PTSD. At the originally recommended cut-off scores (4 for children, 3 for parents), the sensitivity in our sample was 41% for children and 54% for parents. Negative predictive values were 92% for both groups. Adjusting the cut-off scores to 2 improved sensitivity to 82% for children and 92% for parents, with negative predictive values of 92% and 96%, respectively. With adjusted cut-off scores, the STEPP performed well: 82% of the children and 92% of the parents with a subsequent positive diagnosis were identified correctly. Special attention in the screening procedure is required because of a

  8. Macular Diplopia.

    PubMed

    Shippman, Sara; Cohen, Kenneth R; Heiser, Larissa

    2015-01-01

    Maculopathies affect point-to-point foveal correspondence causing diplopia. The effect that the maculopathies have on the interaction of central sensory fusion and peripheral fusion are different than the usual understanding of treatment for diplopia. This paper reviews the pathophysiology of macular diplopia, describes the binocular pathology causing the diplopia, discusses the clinical evaluation, and reviews the present treatments including some newer treatment techniques.

  9. Accidental poisoning with autumn crocus.

    PubMed

    Gabrscek, Lucija; Lesnicar, Gorazd; Krivec, Bojan; Voga, Gorazd; Sibanc, Branko; Blatnik, Janja; Jagodic, Boris

    2004-01-01

    We describe a case of a 43-yr-old female with severe multiorgan injury after accidental poisoning with Colchicum autumnale, which was mistaken for wild garlic (Allium ursinum). Both plants grow on damp meadows and can be confused in the spring when both plants have leaves but no blossoms. The autumn crocus contains colchicine, which inhibits cellular division. Treatment consisted of supportive care, antibiotic therapy, and granulocyte-directed growth factor. The patient was discharged from the hospital after three weeks. Three years after recovery from the acute poisoning, the patient continued to complain of muscle weakness and intermittent episodes of hair loss.

  10. Multifocal electroretinogram and Optical Coherence tomography spectral-domain in arc welding macular injury: a case report

    PubMed Central

    2011-01-01

    Background the purpose of this study was to report a binocular photic retinal injury induced by plasma arc welding and the follow-up after treatment with vitamin supplements for a month. In our study, we used different diagnostic tools such as fluorescein angiography (FA), optical coherence tomography (OCT) and multifocal electroretinogram (mfERG). Case presentation in the first visit after five days from arc welding injury in the left eye (LE) the visual acuity was 0.9 and 1.0 in the right eye (RE). FA was normal in both eyes. OCT in the left eye showed normal profile and normal reflectivity and one month later, a hyperreflectivity appeared in the external limiting membrane (ELM). The mfERG signal in the LE was 102.30 nV/deg2 five days after the injury and 112.62 nV/deg2 after one month and in the RE respectively 142.70 nV/deg2 and 159.46 nV/deg2. Conclusions in cases of retinal photo injury it is important for the ophthalmologist to evaluate tests such as OCT and the mfERG in the diagnosis and follow-up of the patient because the recovery of visual acuity cannot exclude the persistence of phototoxic damage charged to the complex inner-outer segment of photoreceptors. PMID:22208163

  11. Accidental Bowel Leakage

    MedlinePlus

    Member Login Join Pay Dues Follow us: Women's Health Care Physicians Contact Us My ACOG ACOG Departments Donate ... underwear or pads Diarrhea Constipation How will my health care provider diagnose the cause of my accidental bowel ...

  12. Acute accidental phosgene poisoning.

    PubMed

    Gutch, Manish; Jain, Nirdesh; Agrawal, Avinash; Consul, Suchi

    2012-04-02

    Phosgene is a highly toxic gas to which accidental exposure may occur in occupational workers. This case report describes the clinical presentation and management of accidental phosgene poisoning happened after the leakage of phosgene gas from nearby pipeline. The need to suspect phosgene gas exposure and observe such patients is crucial for life saving, especially in view of the delay in clinical deterioration observed in some patients who subsequently develop adult respiratory distress syndrome.

  13. Acute accidental phosgene poisoning

    PubMed Central

    Gutch, Manish; Jain, Nirdesh; Agrawal, Avinash; Consul, Suchi

    2012-01-01

    Phosgene is a highly toxic gas to which accidental exposure may occur in occupational workers. This case report describes the clinical presentation and management of accidental phosgene poisoning happened after the leakage of phosgene gas from nearby pipeline. The need to suspect phosgene gas exposure and observe such patients is crucial for life saving, especially in view of the delay in clinical deterioration observed in some patients who subsequently develop adult respiratory distress syndrome. PMID:22602834

  14. Macular Degeneration Partnership

    MedlinePlus

    ... Age Related Macular Degeneration) Partnership Listen AMD Month Public Service Announcement To raise awareness of AMD, the Macular Degeneration Partnership (MDP) is distributing a public service announcement (PSA) nationwide. Seen through the eyes of a ...

  15. Macular Degeneration: An Overview.

    ERIC Educational Resources Information Center

    Chalifoux, L. M.

    1991-01-01

    This article presents information on macular degeneration for professionals helping persons with this disease adjust to their visual loss. It covers types of macular degeneration, the etiology of the disease, and its treatment. Also considered are psychosocial problems and other difficulties that persons with age-related macular degeneration face.…

  16. Macular Degeneration: An Overview.

    ERIC Educational Resources Information Center

    Chalifoux, L. M.

    1991-01-01

    This article presents information on macular degeneration for professionals helping persons with this disease adjust to their visual loss. It covers types of macular degeneration, the etiology of the disease, and its treatment. Also considered are psychosocial problems and other difficulties that persons with age-related macular degeneration face.…

  17. Composite accidental axions

    NASA Astrophysics Data System (ADS)

    Redi, Michele; Sato, Ryosuke

    2016-05-01

    We present several models where the QCD axion arises accidentally. Confining gauge theories can generate axion candidates whose properties are uniquely determined by the quantum numbers of the new fermions under the Standard Model. The Peccei-Quinn symmetry can emerge accidentally if the gauge theory is chiral. We generalise previous constructions in a unified framework. In some cases these models can be understood as the deconstruction of 5-dimensional gauge theories where the Peccei-Quinn symmetry is protected by locality but more general constructions are possible.

  18. Accidental death involving professional fireworks.

    PubMed

    Romolo, Francesco Saverio; Aromatario, Mariarosaria; Bottoni, Edoardo; Cappelletti, Simone; Fiore, Paola Antonella; Ciallella, Costantino

    2014-01-01

    An interesting case of accidental death involving the explosion of professional fireworks in an apartment is described. The examination of the scene permitted to study several effects of the explosion on walls, ceiling, furniture and especially on a balcony where the victim was found. The external examination of the victim showed extensive thermal injuries, degloving injuries and extensive shrapnel wounds. The autopsy examination showed subarachnoid haemorrhage localized to the cerebellum, haemorrhage in the soft tissues of the neck and chest and fracture of one clavicle. Almost the entire surface of lungs showed blunt injuries and the liver showed tearing of parenchyma and multiple cavities. Histological analysis were carried out showing thickening of alveolar septae, enlargement of alveolar spaces and alveolar ruptures in lung sections while numerous, round, empty spaces were detected in the parenchyma of the liver. The examination of the scene and of the fragments found showed that at least eight pyrotechnical charges exploded on the balcony, in close proximity of the threshold with the living room of the apartment. According to the chemical findings, the charges were typical for professional use and were filled with a mixture of potassium perchlorate and aluminium. A conservative calculation results in more than 1.5 kg total mass of pyrotechnic composition exploding very close to the victim.

  19. Accidental carbon monoxide poisoning.

    PubMed

    Zeller, W P; Miele, A; Suarez, C; Hannigan, J; Hurley, R M

    1984-12-01

    In this case report of an accidental automobile carbon monoxide poisoning, we identify the following risk factors: freezing temperature, young passenger age, location in the rear of the auto, smaller patient mass, and auto disrepair. The pathogenesis of carbon monoxide poisoning is reviewed. Emergency treatment and suggested criteria for hyperbaric oxygen use in pediatric patients are discussed.

  20. Traumatic macular holes secondary to combat ocular trauma.

    PubMed

    Weichel, Eric D; Colyer, Marcus H

    2009-03-01

    This study reports on the visual impact of combat related traumatic macular hole formation at a single tertiary referral center. Retrospective, noncomparative, interventional consecutive case series. Seventeen of 432 consecutive traumatic macular holes occurred in 387 United States soldiers during Operations Iraqi and Enduring Freedom between March 2003 and October 2006. The median age was 28 +/- 9 years (range, 19-49 years) and the median follow-up was 292 +/- 453 days (range, 59-1640 days). Closed-globe macular holes equaled 11 of 234 cases (5%), and open-globe macular holes were 6 of 198 (3%). Traumatic macular hole was associated with a retinal detachment in 8 of 17 cases (47%). The overall documented macular hole closure rate was 9 of 15 cases (60%). There was no statistical difference in hole closure rates between surgery and observation (P = 0.34). Severe nonocular injuries occurred in 12 of 17 (71%), with the median time to macular hole surgical repair of 18 +/- 37 days (range, 7-132). There was a significant positive association between the Ocular Trauma Score equal to or greater than 80 and a best-corrected visual acuity of 20/200 or greater (r = 0.87, n = 15; P < 0.005). Traumatic macular hole occurs in both open and closed globe combat trauma with high rates of nonocular injuries. Visual outcome is highly variable despite macular hole closure in a majority of patients due to concomitant globe injuries. The Ocular Trauma Score is useful in predicting final visual acuity and traumatic macular hole closure.

  1. [Macular serpiginous choroiditis complicated by macular hole].

    PubMed

    Brănişteanu, D; Moraru, Andreea

    2014-01-01

    Macular serpiginouschoroiditis is a rare variant of serpiginous choroiditis characterized by a severe recurrent inflammation of both central choroid and retinal pigment epithelium. Visual prognosis is severe due to subsequent distruction of retinal structures. Permanent central visual loss is the consequence of retinal pigment epithelium hyper or hypoplasia and/or subretinal neovascularization leading to fibrous scarring. This article reports the unusual case of rapid development of a macular hole soon after the onset of characteristic clinical features. Despite anti-inflammatory treatment and successful macular hole surgery the visual function remained significantly impaired by secondary central retinal pigment epithelium changes.

  2. Radiative accidental matter

    NASA Astrophysics Data System (ADS)

    Sierra, D. Aristizabal; Simoes, C.; Wegman, D.

    2016-07-01

    Accidental matter models are scenarios where the beyond-the-standard model physics preserves all the standard model accidental and approximate symmetries up to a cutoff scale related with lepton number violation. We study such scenarios assuming that the new physics plays an active role in neutrino mass generation, and show that this unavoidably leads to radiatively induced neutrino masses. We systematically classify all possible models and determine their viability by studying electroweak precision data, big bang nucleosynthesis and electroweak perturbativity, finding that the latter places the most stringent constraints on the mass spectra. These results allow the identification of minimal radiative accidental matter models for which perturbativity is lost at high scales. We calculate radiative charged-lepton flavor violating processes in these setups, and show that μ → eγ has a rate well within MEG sensitivity provided the lepton-number violating scale is at or below 5×105 GeV, a value (naturally) assured by the radiative suppression mechanism. Sizeable τ → μγ branching fractions within SuperKEKB sensitivity are possible for lower lepton-number breaking scales. We thus point out that these scenarios can be tested not only in direct searches but also in lepton flavor-violating experiments.

  3. Complications of Macular Peeling

    PubMed Central

    Asencio-Duran, Mónica; Manzano-Muñoz, Beatriz; Vallejo-García, José Luis; García-Martínez, Jesús

    2015-01-01

    Macular peeling refers to the surgical technique for the removal of preretinal tissue or the internal limiting membrane (ILM) in the macula for several retinal disorders, ranging from epiretinal membranes (primary or secondary to diabetic retinopathy, retinal detachment…) to full-thickness macular holes, macular edema, foveal retinoschisis, and others. The technique has evolved in the last two decades, and the different instrumentations and adjuncts have progressively advanced turning into a safer, easier, and more useful tool for the vitreoretinal surgeon. Here, we describe the main milestones of macular peeling, drawing attention to its associated complications. PMID:26425351

  4. Macular degeneration in an arc welder.

    PubMed

    Kim, Eun A; Kim, Byung-Gyu; Yi, Cheol-Ho; Kim, Il Gon; Chae, Chang-Ho; Kang, Seong-Kyu

    2007-04-01

    A male welder who had been working in an industrial machine plant for more than 20 years experienced acute intense pain in his left eye with continuous lacrimation while performing arc welding in 1997. Later in 1997, at the age of 39 yr, macular edema was found in his left eye. He was diagnosed with macular degeneration (MD) of the left eye in 2002, and with right eye MD in 2004. Radiation in the visible and near infrared (IR) spectra penetrates the eye and is absorbed by the retina, possibly causing thermal or photochemical damage. Such retinal damage may be permanent and, therefore, sight-threatening. The young age and history of an acute painful eye injury are not consistent with age related macular degeneration (AMD) but rather is likely maculopathy caused by welding arc exposure.

  5. Step length after discrete perturbation predicts accidental falls and fall-related injury in elderly people with a range of peripheral neuropathy.

    PubMed

    Allet, Lara; Kim, Hogene; Ashton-Miller, James; De Mott, Trina; Richardson, James K

    2014-01-01

    Distal symmetric polyneuropathy increases fall risk due to inability to cope with perturbations. We aimed to 1) identify the frontal plane lower limb sensorimotor functions which are necessary for robustness to a discrete, underfoot perturbation during gait; and 2) determine whether changes in the post-perturbed step parameters could distinguish between fallers and non fallers. Forty-two subjects (16 healthy old and 26 with diabetic PN) participated. Frontal plane lower limb sensorimotor functions were determined using established laboratory-based techniques. The subjects' most extreme alterations in step width or step length in response to a perturbation were measured. In addition, falls and fall-related injuries were prospectively recorded. Ankle proprioceptive threshold (APrT; p=.025) and hip abduction rate of torque generation (RTG; p=.041) independently predicted extreme step length after medial perturbation, with precise APrT and greater hip RTG allowing maintenance of step length. Injured subjects demonstrated greater extreme step length changes after medial perturbation than non-injured subjects (percent change = 18.5 ± 9.2 vs. 11.3 ± 4.57; p = .01). The ability to rapidly generate frontal plane hip strength and/or precisely perceive motion at the ankle is needed to maintain a normal step length after perturbation, a parameter which distinguishes between subjects sustaining a fall-related injury and those who did not. © 2014.

  6. Testicular Injuries

    MedlinePlus

    ... Also, the location of the testicles makes them prime targets to be accidentally struck on the playing ... you might also feel nauseated for a short time. If it's a minor testicular injury, the pain ...

  7. Accidental mobile phone card ingestion

    PubMed Central

    Dixit, Sudesh; Mekwan, Jayanand; Brayley, Nigel F

    2009-01-01

    Accidental overdose, poisoning and foreign-body ingestion are common presentations to the emergency department. Usually, the ingested material is a common drug or household product. We present an unusual case of accidental ingestion where the foreign body was a mobile phone simulation (SIM) card. PMID:21686554

  8. Pseudoinflammatory macular dystrophy.

    PubMed

    Carr, R E; Noble, K G

    1977-01-01

    A family with pseudoinflammatory macular dystrophy (PMD) is presented. This dominantly inherited macular dystrophy has its onset in the 3rd to 5th decades with the earliest manifestation being a macular subretinal neovascular network. Visual function tests (ERG, EOG, visual fields, retinal sensitivity) in the early and late stages indicates this is local or geographic disease. This dystrophy should be differentiated from other hereditary causes for subretinal neovascularization (angioid streaks, vitelliform dystrophy, dominant drusen of Bruch's membrane, optic nerve drusen and myopia). It is suggested that treatment be directed at early obliteration of the subretinal neovascularization with intense photocoagulation since the outcome in virtually all cases of untreated PMD is legal blindness.

  9. Inherited complement regulatory protein deficiency predisposes to human disease in acute injury and chronic inflammatory statesthe examples of vascular damage in atypical hemolytic uremic syndrome and debris accumulation in age-related macular degeneration.

    PubMed

    Richards, Anna; Kavanagh, David; Atkinson, John P

    2007-01-01

    In this chapter, we examine the role of complement regulatory activity in atypical hemolytic uremic syndrome (aHUS) and age-related macular degeneration (AMD). These diseases are representative of two distinct types of complement-mediated injury, one being acute and self-limited, the other reflecting accumulation of chronic damage. Neither condition was previously thought to have a pathologic relationship to the immune system. However, alterations in complement regulatory protein genes have now been identified as major predisposing factors for the development of both diseases. In aHUS, heterozygous mutations leading to haploinsufficiency and function-altering polymorphisms in complement regulators have been identified, while in AMD, polymorphic haplotypes in complement genes are associated with development of disease. The basic premise is that a loss of function in a plasma or membrane inhibitor of the alternative complement pathway allows for excessive activation of complement on the endothelium of the kidney in aHUS and on retinal debris in AMD. These associations have much to teach us about the host's innate immune response to acute injury and to chronic debris deposition. We all experience cellular injury and, if we live long enough, will deposit debris in blood vessel walls (atherosclerosis leading to heart attacks and strokes), the brain (amyloid proteins leading to Alzheimer's disease), and retina (lipofuscin pigments leading to AMD). These are three common causes of morbidity and mortality in the developed world. The clinical, genetic, and immunopathologic understandings derived from the two examples of aHUS and AMD may illustrate what to anticipate in related conditions. They highlight how a powerful recognition and effector system, the alternative complement pathway, reacts to altered self. A response to acute injury or chronic debris accumulation must be appropriately balanced. In either case, too much activation or too little regulation promotes

  10. Healing of Genital Injuries

    ERIC Educational Resources Information Center

    Berkowitz, Carol D.

    2011-01-01

    Child sexual abuse as well as accidental trauma may cause acute injuries in the anogenital area. Most data on residual findings following genital trauma come from longitudinal studies of children who have been sexually assaulted, undergone surgical procedures, or experienced accidental trauma. Like injuries in other part parts of the body, such…

  11. Healing of Genital Injuries

    ERIC Educational Resources Information Center

    Berkowitz, Carol D.

    2011-01-01

    Child sexual abuse as well as accidental trauma may cause acute injuries in the anogenital area. Most data on residual findings following genital trauma come from longitudinal studies of children who have been sexually assaulted, undergone surgical procedures, or experienced accidental trauma. Like injuries in other part parts of the body, such…

  12. Spontaneous macular hole closure in bilateral macular holes.

    PubMed

    Win, Peter H; Young, Tara A

    2007-01-01

    The natural course of full thickness macular hole is progression in size and stage. There have been reports of spontaneous closure of unilateral idiopathic full thickness macular holes, but we report the first case of spontaneous closure of a full thickness macular hole in one eye in a patient with bilateral idiopathic full thickness macular holes. After macular hole surgery in the left eye of the patient, spontaneous closure of the macular hole in the right eye was observed during the follow-up period.

  13. Wet Macular Degeneration

    MedlinePlus

    ... has a hereditary component. Researchers have identified several genes related to developing the condition. Smoking. Smoking cigarettes or being regularly exposed to smoke significantly increases your risk of macular degeneration. Obesity. Research indicates that being obese increases the chance ...

  14. Epidemiology of accidental radiation exposures.

    PubMed Central

    Cardis, E

    1996-01-01

    Much of the information on the health effects of radiation exposure available to date comes from long-term studies of the atomic bombings in Hiroshima and Nagasaki. Accidental exposures, such as those resulting from the Chernobyl and Kyshtym accidents, have as yet provided little information concerning health effects of ionizing radiation. This paper will present the current state of our knowledge concerning radiation effects, review major large-scale accidental radiation exposures, and discuss information that could be obtained from studies of accidental exposures and the types of studies that are needed. PMID:8781398

  15. Epidemiology of accidental radiation exposures.

    PubMed

    Cardis, E

    1996-05-01

    Much of the information on the health effects of radiation exposure available to date comes from long-term studies of the atomic bombings in Hiroshima and Nagasaki. Accidental exposures, such as those resulting from the Chernobyl and Kyshtym accidents, have as yet provided little information concerning health effects of ionizing radiation. This paper will present the current state of our knowledge concerning radiation effects, review major large-scale accidental radiation exposures, and discuss information that could be obtained from studies of accidental exposures and the types of studies that are needed.

  16. Accidental dapsone poisoning in children.

    PubMed

    Nair, P M; Philip, E

    1984-12-01

    Accidental poisoning in children shows a trend towards poisoning with various newer drugs and chemicals used in the household. Sixty-one cases of accidental poisoning in children were seen in Sree Avittam Thirunal Hospital, (S.A.T.H.), Trivandrum, South India during the year 1982, constituting 0.61% of the total pediatric admissions. Dapsone poisoning constituted 9.8% of the total accidental poisonings, emphasising the need for safe storage of drugs out of the reach of young children. Dapsone poisoning with resultant methaemoglobinaemia responded well to intravenous ascorbic acid and other supportive measures.

  17. Cataracts and macular degeneration.

    PubMed

    Shoch, D

    1979-09-01

    The intraocular lens restores general vision and some degree of independence and mobility to patients with dense cataracts and macular degeneration. The patient, however, must be repeatedly warned that fine central vision, particularly reading, will not be possible after the surgery. An aphakic spectacle leaves such patients a narrow band of vision when superimposed over the macular lesion, and contact lenses are too small for the patient to manage insertion without help.

  18. Accidental or inflicted?

    PubMed

    Thompson, Sara

    2005-05-01

    The visible evidence of child physical abuse most often is minimal or nonexistent, and the children at greatest risk of becoming victims are those too young to verbalize the history. As pediatric clinicians, we must be able to recognize potential sequelae of abuse and the high-risk situations that lead to physical abuse; we also must acknowledge that victims of child physical abuse often have injuries at multiple locations and in multiple organ systems. As a routine part of pediatric practice, healthcare providers, through anticipatory guidance, try to maximize the child's safety in the home environment. With this goal in mind, healthcare providers must consider the possibility of physical abuse when faced with a child with a traumatic injury. While it is important to identify these inflicted injuries, our ultimate goal is to prevent their occurrence in the first place.

  19. Management of traumatic macular holes: case report.

    PubMed

    Brasil, Oswaldo Ferreira Moura; Brasil, Oswaldo Moura

    2008-01-01

    Traumatic macular hole is a disease whose pathogenesis is not fully understood and the best treatment guideline is controversial. We report 2 cases of traumatic macular hole with different treatment approaches. In the first case, a 9-year-old boy presented with a traumatic macular hole secondary to blunt ocular trauma with a stone, and initial vision of 20/300. He underwent surgical repair and his final vision was 20/70 with hole closure after a 1 year follow-up. In the second case, a 20-year-old woman suffered a penetrating bullet wound on the left side of her forehead. The injury caused optic nerve head avulsion in the left eye with loss of light perception. The right eye had a traumatic macular hole and signs suggestive of sclopetaria chorioretinitis, with 20/60 vision. This case was initially observed and vision improved to 20/30 with reduction of the hole diameter. Vision and hole diameter remained stable after 8 months.

  20. Spontaneous closure of a blue laser induced full thickness macular hole.

    PubMed

    Porrúa, L; Oblanca, N; González-López, J J

    2017-01-01

    A 14 year-old boy attended our clinic complaining of a scotoma after an accidental exposure to a 10W, 450nm laser beam from a blue-light handheld laser device. Optical coherence tomography confirmed a full thickness macular hole. As visual acuity (VA) remained 20/20 Snellen, observation was decided. Spontaneous closure was confirmed after one month. Reckless use of high-power handheld laser devices may induce severe retinal lesions, including full thickness macular holes. Observation is a sensible treatment option in this type of macular hole, especially when VA is preserved. The pathophysiology of these cases differs from senile full thickness macular holes. Copyright © 2016 Sociedad Española de Oftalmología. Publicado por Elsevier España, S.L.U. All rights reserved.

  1. X-82 to Treat Age-related Macular Degeneration

    ClinicalTrials.gov

    2017-01-12

    Age-Related Macular Degeneration (AMD); Macular Degeneration; Exudative Age-related Macular Degeneration; AMD; Macular Degeneration, Age-related, 10; Eye Diseases; Retinal Degeneration; Retinal Diseases

  2. [My accidental discovery].

    PubMed

    Nakamura, Tatsuya

    2008-10-01

    gleaned from my one accidental discovery.

  3. Accidental puncture or laceration in colorectal surgery: a quality indicator or a complexity measure?

    PubMed

    Kin, Cindy; Snyder, Karen; Kiran, Ravi P; Remzi, Feza H; Vogel, Jon D

    2013-02-01

    Accidental puncture or laceration during a surgical procedure is a patient safety indicator that is publicly reported and will factor into the Centers for Medicare and Medicaid's pay-for-performance plan. Accidental puncture or laceration includes serosal tear, enterotomy, and injury to the ureter, bladder, spleen, or blood vessels. This study aimed to identify risk factors and assess surgical outcomes related to accidental puncture or laceration. This is a retrospective study. This study was conducted in a single-hospital department of colorectal surgery. Inpatients undergoing colorectal surgery in which an accidental puncture or laceration did or did not occur were selected. The primary outcomes measured were surgical complications, length of stay, and readmission. Of 2897 operations, 269 had accidental puncture or laceration (9.2%) including serosal tear (47%), enterotomy (38%), and extraintestinal injuries (15%). Accidental puncture or laceration cases had more diagnoses of enterocutaneous fistula (11% vs 2%, p < 0.001), reoperative cases (91% vs 61%, p < 0.001), open surgery (96% vs 77%, p < 0.001), longer operative times (186 vs 146 minutes, p = 0.001), and increased length of stay (10 vs 7 days, p = 0.002). Patients with serosal tears had entirely similar outcomes to those without an injury, whereas patients with enterotomies had increased operative times and length of stay, and patients with extraintestinal injuries had higher rates of reoperation and sepsis (p < 0.05 for all). This study was limited by the loss of sensitivity due to grouping extraintestinal injuries. Accidental puncture or laceration is more likely to occur in complex colorectal operations. The clinical consequences range from none to significant depending on the specific type of injury. To make accidental puncture or laceration a more meaningful quality indicator, we advocate that groups who use the measure eliminate the injuries that have no bearing on surgical outcome and that risk

  4. AGE-RELATED MACULAR DEGENERATION.

    PubMed

    Gheorghe, Andreea; Mahdi, Labib; Musat, Ovidiu

    2015-01-01

    The objective of our study was to review the current knowledge on Age- Related Macular Degeneration, including pathogenesis, ocular manifestations, diagnosis and ancillary testing. Relevant publications on Age-Related Macular Degeneration that were published until 2014. Age-related macular degeneration (AMD) is a common macular disease affecting elderly people in the Western world. It is characterized by the appearance of drusen in the macula, accompanied by choroidal neovascularization (CNV) or geographic atrophy.

  5. Differentiating full thickness macular holes from impending macular holes and macular pseudoholes

    PubMed Central

    Tsujikawa, M.; Ohji, M.; Fujikado, T.; Saito, Y.; Motokura, M.; Ishimoto, I.; Tano, Y.

    1997-01-01

    AIMS—The reliability of scanning laser ophthalmoscope (SLO) microperimetry in differentiating full thickness macular holes from macular pseudoholes and impending macular holes was evaluated.
METHODS—106 eyes with the clinical diagnosis of full thickness macular holes, macular pseudoholes, and impending (stage 1) macular holes were examined for the presence of deep or relative scotoma using SLO microperimetry. The relation between these scotomas and the clinical diagnosis was studied.
RESULTS—Deep and relative scotomas were detected in all 57 eyes with clinically defined full thickness macular holes. In contrast, among 49 eyes diagnosed with macular pseudoholes or impending macular holes, no deep and only one relative scotoma was observed. The sensitivity of the presence of a deep scotoma as an indicator of the clinical diagnosis of a full thickness macular hole was 100% (57 of 57), and the specificity was 100% (49 of 49). The sensitivity of the presence of a relative scotoma was 100% (57 of 57) and the specificity was 98.0% (48 of 49).
CONCLUSION—With SLO microperimetry, full thickness macular holes can be precisely and objectively distinguished from other conditions that mimic macular holes.

 PMID:9059244

  6. Diabetic Macular Edema

    NASA Astrophysics Data System (ADS)

    Lobo, Conceição; Pires, Isabel; Cunha-Vaz, José

    The optical coherence tomography (OCT), a noninvasive and noncontact diagnostic method, was introduced in 1995 for imaging macular diseases. In diabetic macular edema (DME), OCT scans show hyporeflectivity, due to intraretinal and/or subretinal fluid accumulation, related to inner and/or outer blood-retinal barrier breakdown. OCT tomograms may also reveal the presence of hard exudates, as hyperreflective spots with a shadow, in the outer retinal layers, among others. In conclusion, OCT is a particularly valuable diagnostic tool in DME, helpful both in the diagnosis and follow-up procedure.

  7. Intravitreal injection of docosahexaenoic acid attenuated photoreceptor cell injury in a NaIO3-induced age-related macular degeneration rat model.

    PubMed

    Qiu, Suo; Wei, Yantao; Zhou, Xuezhi; Jiang, Zhaoxin; Zhang, Ting; Jiang, Xintong; Zhang, Shaochong

    2017-09-14

    In most studies, the major supplement docosahexaenoic acid (DHA) is administered orally or intraperitoneally. In this study, we proposed to assess the safety and efficacy of the intravitreal injection of DHA in an age-related macular degeneration (AMD) rat model. Different concentrations of DHA were injected into the vitreous body. Histopathology and terminal deoxynucleotidyl transferase dUTP nick-end labeling (TUNEL) analysis showed that there was no difference in thickness, observable structure, or apoptosis among the untreated, normal saline, and DHA groups (0.2, 1.0, 5.0 and 10μg). However, GFAP expression was increased in the 10μg group. To investigate whether intravitreal injection of DHA could protect photoreceptors, we developed a NaIO3-induced retinal damage model in adult rats. Decreases in deformation and thickness were observed in the outer nuclear layer (ONL) after NaIO3 administration but were improved with DHA injection. The NaIO3 group showed a substantial reduction in the number of nuclei in ONL, whereas the DHA group showed an increase. Additionally, significant increases in SOD activity and Nrf2 expression were observed after DHA injection; GFAP and NF-κB expression levels were markedly decreased by DHA injection. Moreover, Western blotting showed that Bax, cleaved caspase-3 and CHOP were notably increased in the NaIO3 group but were significantly decreased by DHA injection. Collectively, intravitreal injection of DHA is safe and effective in select doses in a NaIO3-induced AMD rat model. The current results suggest that intravitreal injection of DHA may be a new avenue for the treatment of AMD. Copyright © 2017 Elsevier B.V. All rights reserved.

  8. Epidemiology of accidental radiation exposures

    SciTech Connect

    Cardis, E.

    1996-05-01

    Much of the information on the health effects of radiation exposure available to date comes from long-term studies of the atomic bombings in Hiroshima and Nagasaki. Accidental exposures, such as those resulting from the Chernobyl and Kyshtym accidents, have as yet provided little information concerning health effects of ionizing radiation. This paper will present the current state of our knowledge concerning radiation effects, review major large-scale accidental exposures and the types of studies that are needed. 64 refs., 3 tabs.

  9. Macular telangiectasia type 2

    PubMed Central

    Issa, Peter Charbel; Gillies, Mark C.; Chew, Emily Y.; Bird, Alan C.; Heeren, Tjebo F.C.; Peto, Tunde; Holz, Frank G.; Scholl, Hendrik P.N.

    2013-01-01

    Macular telangiectasia type 2 is a bilateral disease of unknown cause with characteristic alterations of the macular capillary network and neurosensory atrophy. Its prevalence may be underestimated and has recently been shown to be as high as 0.1% in persons 40 years and older. Biomicroscopy may show reduced retinal transparency, crystalline deposits, mildly ectatic capillaries, blunted venules, retinal pigment plaques, foveal atrophy, and neovascular complexes. Fluorescein angiography shows telangiectatic capillaries predominantly temporal to the foveola in the early phase and a diffuse hyperfluorescence in the late phase. High-resolution optical coherence tomography (OCT) may reveal disruption of the photoreceptor inner segment–outer segment border, hyporeflective cavities at the level of the inner or outer retina, and atrophy of the retina in later stages. Macular telangiectasia type 2 shows a unique depletion of the macular pigment in the central retina and recent therapeutic trials showed that such depleted areas cannot re-accumulate lutein and zeaxanthin after oral supplementation. There have been various therapeutic approaches with limited or no efficacy. Recent clinical trials with compounds that block vascular endothelial growth factor (VEGF) have established the role of VEGF in the pathophysiology of the disease, but have not shown significant efficacy, at least for the nonneovascular disease stages. Recent progress in structure–function correlation may help to develop surrogate outcome measures for future clinical trials. In this review article, we summarize the current knowledge on macular telangiectasia type 2, including the epidemiology, the genetics, the clinical findings, the staging and the differential diagnosis of the disease. Findings using retinal imaging are discussed, including fluorescein angiography, OCT, adaptive optics imaging, confocal scanning laser ophthalmoscopy, and fundus autofluorescence, as are the findings using visual

  10. Conservative management of accidental gall bladder puncture during percutaneous nephrolithotomy

    PubMed Central

    Patil, Nikhil A.; Patil, Siddangouda B.; Biradar, Ashok N.; Desai, Anup S.

    2014-01-01

    Percutaneous nephrolithotomy (PCNL) has been an excellent option for the management of kidney stones. There have been many complications in regards to solid organ injury during PCNL. Here we discuss an interesting case of 45-year-old woman, who underwent PCNL for right renal staghorn calculus, and had an accidental puncture of the gall bladder. Post operatively, the patient was conservatively managed and recovered well. A small number of cases has been reported until now in literature. PMID:25140237

  11. Conservative management of accidental gall bladder puncture during percutaneous nephrolithotomy.

    PubMed

    Patil, Nikhil A; Kundargi, Vinay S; Patil, Siddangouda B; Biradar, Ashok N; Desai, Anup S

    2014-01-01

    Percutaneous nephrolithotomy (PCNL) has been an excellent option for the management of kidney stones. There have been many complications in regards to solid organ injury during PCNL. Here we discuss an interesting case of 45-year-old woman, who underwent PCNL for right renal staghorn calculus, and had an accidental puncture of the gall bladder. Post operatively, the patient was conservatively managed and recovered well. A small number of cases has been reported until now in literature.

  12. Genetics Home Reference: Stargardt macular degeneration

    MedlinePlus

    ... Genetics Home Health Conditions Stargardt macular degeneration Stargardt macular degeneration Enable Javascript to view the expand/collapse boxes. Download PDF Open All Close All Description Stargardt macular degeneration is a genetic eye disorder that causes progressive ...

  13. [Complex pelvic trauma caused by an accidental side split].

    PubMed

    Heinermann, J D B; Hessmann, M H; Rommens, P M

    2005-04-01

    Complex pelvic ring fractures are defined as injuries of the pelvic ring in association with lesions of the pelvic organs or the pelvic soft tissues. These injuries are typically caused by high-energy accidents. In contrast to the typical mechanism of injury a case is described in which a low energy trauma led to a complex pelvic ring trauma. An obese woman suffered an open-book injury of the pelvis with severe open urogenital soft-tissue damage by accidentally doing forced splits. Primary stabilization of the pelvic ring with external fixation and secondary internal fixation with a double-plate osteosynthesis of the symphysis led to a good clinical outcome concerning the osseous lesion. The urogenital injuries with rupture of the bladder, the urethra and the vagina led despite immediate urological management to an incontinence, which finally required definitive urine drainage via an ileum conduit.

  14. MACULAR ATROPHY AND MACULAR MORPHOLOGY IN AFLIBERCEPT-TREATED NEOVASCULAR AGE-RELATED MACULAR DEGENERATION.

    PubMed

    Kuroda, Yoshimasa; Yamashiro, Kenji; Ooto, Sotaro; Tamura, Hiroshi; Oishi, Akio; Nakanishi, Hideo; Miyata, Manabu; Hata, Masayuki; Takahashi, Ayako; Wakazono, Tomotaka; Yoshimura, Nagahisa; Tsujikawa, Akitaka

    2017-07-04

    To investigate the incidence and predictors of macular atrophy during treatment with aflibercept for neovascular age-related macular degeneration in Japanese patients. This study included patients with treatment-naive subfoveal neovascular age-related macular degeneration treated from December 2012 through January 2015. Patients were treated with bi-monthly aflibercept injections after 3 monthly loading injections for the first year. Diagnosis of retinal pigment epithelial atrophy was made based on color fundus photography, spectral-domain optical coherence tomography, and fundus autofluorescence. Baseline characteristics and morphological features were analyzed for their association with the development of macular atrophy. This study included 123 eyes that had no baseline macular atrophy and treated with aflibercept injections for 12 months. Thirteen eyes (10.6%) developed new macular atrophy at 12 months. Logistic regression analysis showed that the presence of intraretinal fluid and thinner subfoveal choroidal thickness at baseline were associated with the development of macular atrophy after aflibercept treatment. Macular atrophy developed in about 10% of eyes with neovascular age-related macular degeneration during 12 months of treatment with a fixed regimen of aflibercept. Intraretinal fluid and subfoveal choroidal thickness seem to be predictors for development of macular atrophy after anti-vascular endothelial growth factor (VEGF) therapy.

  15. Accidental infusion leakage at subgalea in infants: report of 6 cases

    PubMed Central

    An, Bo; Ning, Haojie

    2015-01-01

    Infiltration remains the commonest iatrogenic injury within infants care. We report a series of 6 infants affected by accidental infusion leakage occurring in subgalea. They were applied wet-hot compresses by sterile gauze, and topically administrated mucopolysaccharide polysulfate (MPS) cream following hot compress. There was no skin impairment in all cases. Early recognition and appropriate care for topical skin are essential to minimize the extent of accidental infusion leakage. PMID:26550108

  16. [Pathopshysiological mechanisms in macular edema].

    PubMed

    Turlea, Cristian; Zolog, Ileana; Blăjan, Codruta; Roşca, C; Turlea, Magdalena; Munteanu, Mihnea; Boruga, Ovidiu

    2014-01-01

    The treatment of diabetic macular edema has known a fast development in the last 5 years where the transition from laser monotherapy to intravitreal pharmacotherapy is becoming standard practice. Intravitreal injections therapy is in a continuous development with promising positive results. The use of intratvitreal devices in the treatment of macular edema of vascular cause has become a viable alternative also in treating diabetic macular edema. Several clinical studies have revealed the superiority of intravitreal treatment versus laser monotherapy. This article is evaluating and reviewing present and future treatments used to combat diabetic macular edema. [corrected].

  17. [Management of severe accidental hypothermia].

    PubMed

    Avellanas, M L; Ricart, A; Botella, J; Mengelle, F; Soteras, I; Veres, T; Vidal, M

    2012-04-01

    Accidental hypothermia is an environmental condition with basic principles of classification and resuscitation that apply to mountain, sea or urban scenarios. Along with coagulopathy and acidosis, hypothermia belongs to the lethal triad of trauma victims requiring critical care. A customized healthcare chain is involved in its management, extending from on site assistance to intensive care, cardiac surgery and/or the extracorporeal circulation protocols. A good classification of the degree of hypothermia preceding admission contributes to improve management and avoids inappropriate referrals between hospitals. The most important issue is to admit hypothermia victims in asystolia or ventricular fibrillation to those hospitals equipped with the medical technology which these special clinical scenarios require. This study attempts to establish the foundations for optimum management of accidental hypothermia from first emergency care on site to treatment in hospital including, resuscitation and rewarming with extracorporeal circulation. Copyright © 2011 Elsevier España, S.L. and SEMICYUC. All rights reserved.

  18. [Accidental poisoning in the home].

    PubMed

    Lindblad, B E; Terkelsen, C J

    1989-09-25

    During a period of one year, a total of 79 cases of accidental poisoning were registered prospectively in the County Hospital in Aarhus and the City Hospital in Randers. The female/male ratio was 1/1.5. The incidence in children aged 0-14 years of age was 13 per 10,000. In Denmark as a whole, a total of 1,300 cases of accidental poisoning were estimated to occur during a period of one year. Sixty-four (81%) of the accidents occurred in small children aged 0-4 years. Twenty-five patients (32%) were hospitalized. The average duration of hospitalization was 2.4 days (1-4 days) and 84% of the inpatients were aged 0-4 years. The survey revealed that 27 case of accidental poisoning were due to medicine, 20 to organic solvents, eight to chemicals, 22 to poison and two to asphyxiation. It is concluded that the special legal regulations about packing and labelling are not sufficient when storage of the potential poison is not safe enough.

  19. Accidental intraoral injection of formalin during extraction: case report.

    PubMed

    Swami, Pushp Chander; Raval, Rushik; Kaur, Mandeep; Kaur, Jasleen

    2016-04-01

    Transparent, clear solutions such as hydrogen peroxide, alcohol, sodium hypochlorite, formaldehyde, and local anaesthetics are widely used in dentistry, so the tissues are liable to accidental injury. Formalin, a 37%-40% solution of formaldehyde, is extensively used in 10% solution as a tissue preservative, but it has toxic effects on systems such as the gastrointestinal tract, respiratory tract, skin, and mucosa. However, we know of few reports of cases of inadvertent injection of alcohol and formalin directly into the human body. In this case report we describe the early and delayed clinical effects of accidental intraoral injection of formalin, the subsequent symptoms and management, and some prudent points that should be learnt to avoid such incidents in the future. Copyright © 2015 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  20. Injury to the prepuce.

    PubMed

    Yip, A; Ng, S K; Wong, W C; Li, M K; Lam, K H

    1989-05-01

    Injury to the prepuce is uncommon. A total of 32 patients were treated within a 3-year period. A difference in the aetiology between boys and adults was noted. Accidental injury to the prepuce occurred in 6 boys, with zipper injuries being the commonest among children. Coital and self-inflicted injuries accounted for 85% of adult cases. In patients with coital injuries, predisposing phimosis or a short frenulum was common.

  1. Paediatric femur fractures at the emergency department: accidental or not?

    PubMed Central

    Vrolijk-Bosschaart, Thekla F; Bakx, Roel; Van Rijn, Rick R.

    2016-01-01

    Only a small proportion of all paediatric fractures is caused by child abuse or neglect, especially in highly prevalent long bone fractures. It can be difficult to differentiate abusive fractures from non-abusive fractures. This article focuses on femoral fractures in young children. Based on three cases, this article presents a forensic evidence-based approach to differentiate between accidental and non-accidental causes of femoral fractures. We describe three cases of young children who were presented to the emergency department because of a suspected femur fracture. Although in all cases, the fracture had a similar location and appearance, the clinical history and developmental stage of the child led to three different conclusions. In the first two cases, an accidental mechanism was a plausible conclusion, although in the second case, neglect of parental supervision was the cause for concern. In the third case, a non-accidental injury was diagnosed and appropriate legal prosecution followed. Any doctor treating children should always be aware of the possibility of child abuse and neglect in children with injuries, especially in young and non-mobile children presenting with an unknown trauma mechanism. If a suspicion of child abuse or neglect arises, a thorough diagnostic work-up should be performed, including a full skeletal survey according to the guidelines of the Royal College of Radiologists and the Royal College of Paediatrics and Child Health. In order to make a good assessment, the radiologist reviewing the skeletal survey needs access to all relevant clinical and social information. PMID:26642309

  2. Gold granuloma after accidental implantation.

    PubMed Central

    Scott, F R; Dhillon, A P; Lewin, J F; Flavell, W; Laws, I M

    1995-01-01

    A case, in a 66 year old man, of a florid granulomatous reaction to gold dental alloy presenting about 20 years after accidental implantation in the oral mucosa of the lip is reported. Subsequent energy dispersive analysis confirmed the presence of a high nobility gold dental alloy. Florid granulomatosis has only rarely been reported in association with gold. Possible explanations for the delay in presentation include alteration of immune status or the development of hypersensitivity with components of the gold dental alloy acting as haptens. Images PMID:8543638

  3. Achondroplasia and Macular Coloboma.

    PubMed

    Ahoor, M H; Amizadeh, Y; Sorkhabi, R

    2015-01-01

    Achondroplasia is an autosomal dominant congenital disorder of enchondral ossification. It is clinically characterized by low stature, craniofacial deformity, and vertebral malformation. Associated ophthalmic features include telecanthus, exotropia, angle anomalies, and cone-rod dystrophy. A 24-year-old male presented with decreased vision bilaterally and typical achondroplasia. The best corrected visual acuity was 20/70 in both eyes. Anterior segment examination was normal. Fundus examination revealed a well-demarcated circular paramacular lesion in both eyes. As macular coloboma and achondroplasia are developmental disorders, the funduscopic examination is required in patients with achondroplasia.

  4. Age-Related Macular Degeneration

    MedlinePlus

    ... version of this page please turn Javascript on. Age-related Macular Degeneration About AMD Click for more ... a leading cause of vision loss among people age 60 and older. It causes damage to the ...

  5. About Assessment Criteria of Driver's Accidental Abilities

    ERIC Educational Resources Information Center

    Lobanova, Yuliya I.; Glushko, Kirill V.

    2016-01-01

    The article points at the importance of studying the human factor as a cause of accidents of drivers, especially in loosely structured traffic situations. The description of the experiment on the measurement of driver's accidental abilities is given. Under accidental ability is meant the capability to ensure the security of driving as a behavior…

  6. Field Management of Accidental Hypothermia during Diving

    DTIC Science & Technology

    1990-01-01

    Case history number 97: Core rewarming by peritoneal irrigation in accidental hypothermia with cacdiac arrest. Anesth Analg 1966; 56:574-577. 85. Lint-n...Intractable ventricular fibrillation associated with profound accidental hypothermia - Successful treatment with ;irtial cardiopulmonary bypass . N Engl...5 B. CLINICAL ASSESSMENT OF THE HYPOTHERMIC DIVER ................ 6 C. FIELD TREATMENT OF HYPOTHERMIA. A REVIEW OF THE LITERATURE 9 D

  7. Accidental asphyxia in bed in severely disabled children.

    PubMed

    Amanuel, B; Byard, R W

    2000-02-01

    To determine whether there are specific situations which may increase the risk of accidental asphyxia during sleep in children with physical and mental disabilities. Review of all cases where death was attributed to accidental asphyxia caused by unsafe sleeping situations in children listed in the Department of Histopathology database over a 10-year period from March 1989 to February 1999. A total of 26 cases were found (M:F, 19:7; age range, 1-48 months; average age, 7.4 months). Of those cases, two involved children with significant mental and physical impairment. Case 1: A 4-year-old boy with Klippel-Trenaunay-Weber syndrome, macrocephaly and severe developmental delay, was found dead with his head hanging over a wooden board attached to the side of his bed. Case 2: A 4-year-old boy with lissencephaly and severe developmental delay was found dead wedged between a retractable mesh cot side and the side of his bed. In both cases the devices resulting in death had been put in place to prevent the boys from falling out of bed. Accidental asphyxia in physically and mentally impaired children may be caused by devices that have been used to prevent injury from falling out of bed. Careful assessment of the specific developmental problems that children suffer should be undertaken before their beds are modified. It may be safer for these children either to have no barrier, or to have drop-sided cots/beds that meet recognized safety standards.

  8. Accidental inflation in the landscape

    NASA Astrophysics Data System (ADS)

    Blanco-Pillado, Jose J.; Gomez-Reino, Marta; Metallinos, Konstantinos

    2013-02-01

    We study some aspects of fine tuning in inflationary scenarios within string theory flux compactifications and, in particular, in models of accidental inflation. We investigate the possibility that the apparent fine-tuning of the low energy parameters of the theory needed to have inflation can be generically obtained by scanning the values of the fluxes over the landscape. Furthermore, we find that the existence of a landscape of eternal inflation in this model provides us with a natural theory of initial conditions for the inflationary period in our vacuum. We demonstrate how these two effects work in a small corner of the landscape associated with the complex structure of the Calabi-Yau manifold P4[1,1,1,6,9] by numerically investigating the flux vacua of a reduced moduli space. This allows us to obtain the distribution of observable parameters for inflation in this mini-landscape directly from the fluxes.

  9. Is the tribimaximal mixing accidental?

    SciTech Connect

    Abbas, Mohammed; Smirnov, A. Yu.

    2010-07-01

    The tribimaximal (TBM) mixing is not accidental if structures of the corresponding leptonic mass matrices follow immediately from certain (residual or broken) flavor symmetry. We develop a simple formalism which allows one to analyze effects of deviations of the lepton mixing from TBM on the structure of the neutrino mass matrix and on the underlying flavor symmetry. We show that possible deviations from the TBM mixing can lead to strong modifications of the mass matrix and strong violation of the TBM-mass relations. As a result, the mass matrix may have an 'anarchical' structure with random values of elements or it may have some symmetry that differs from the TBM symmetry. Interesting examples include matrices with texture zeros, matrices with certain 'flavor alignment' as well as hierarchical matrices with a two-component structure, where the dominant and subdominant contributions have different symmetries. This opens up new approaches to understanding the lepton mixing.

  10. Accidental hypothermia in severe trauma.

    PubMed

    Vardon, Fanny; Mrozek, Ségolène; Geeraerts, Thomas; Fourcade, Olivier

    2016-10-01

    Hypothermia, along with acidosis and coagulopathy, is part of the lethal triad that worsen the prognosis of severe trauma patients. While accidental hypothermia is easy to identify by a simple measurement, it is no less pernicious if it is not detected or treated in the initial phase of patient care. It is a multifactorial process and is a factor of mortality in severe trauma cases. The consequences of hypothermia are many: it modifies myocardial contractions and may induce arrhythmias; it contributes to trauma-induced coagulopathy; from an immunological point of view, it diminishes inflammatory response and increases the chance of pneumonia in the patient; it inhibits the elimination of anaesthetic drugs and can complicate the calculation of dosing requirements; and it leads to an over-estimation of coagulation factor activities. This review will detail the pathophysiological consequences of hypothermia, as well as the most recent principle recommendations in dealing with it.

  11. Electric fences and accidental death.

    PubMed

    Burke, Michael; Odell, Morris; Bouwer, Heinrich; Murdoch, Adam

    2017-03-28

    Deaths which occur in association with agricultural electric fences are very rare. In fact, electric fences have undoubtedly saved numerous human and animal lives by safely and reliably keeping livestock confined to their fields and enclosures and thus preventing motor vehicle incidents when livestock get onto roads and highways. Accidental and intentional human contact with electric fences occurs regularly and causes little more than transient discomfort, however, on exceptional occasions, contact with electric fences appears to be directly related to the death of the individual. The precise pathophysiological cause of these deaths is unclear. We present two cases of deaths associated with electric fences, discuss the possible pathophysiological mechanisms in these cases, and suggest a universal approach to the medico-legal investigation and documentation of these deaths.

  12. Accidental decapitation: a case report.

    PubMed

    Demirci, Serafettin; Dogan, Kamil Hakan; Erkol, Zerrin; Gunaydin, Gursel

    2009-09-01

    We report a case of an accidental decapitation of an agriculture worker in a field. The scene investigation revealed that the worker had loosely tied a scarf tied over his face in an attempt to diminish his exposure to barley dust, to which he was allergic, while distributing the barley loads with a shovel upon a trailer. The trailer was simultaneously being loaded by a helix elevator machine and its rotating shaft suddenly caught the victim's scarf and pulled it down to the victim's neck. The rotating motion immediately tightened the scarf around the neck resulting in hanging/strangulation noose that, by continued tightening, caused decapitation of the victim. The victim's body was found on the ground by the trailer and the victim's head was discovered in the barley load in the trailer. Examination revealed that the neck was severed at the level of the second and third cervical vertebrae.

  13. Accidental inflation in the landscape

    SciTech Connect

    Blanco-Pillado, Jose J.; Metallinos, Konstantinos; Gomez-Reino, Marta E-mail: marta.gomez-reino.perez@cern.ch

    2013-02-01

    We study some aspects of fine tuning in inflationary scenarios within string theory flux compactifications and, in particular, in models of accidental inflation. We investigate the possibility that the apparent fine-tuning of the low energy parameters of the theory needed to have inflation can be generically obtained by scanning the values of the fluxes over the landscape. Furthermore, we find that the existence of a landscape of eternal inflation in this model provides us with a natural theory of initial conditions for the inflationary period in our vacuum. We demonstrate how these two effects work in a small corner of the landscape associated with the complex structure of the Calabi-Yau manifold P{sup 4}{sub [1,1,1,6,9]} by numerically investigating the flux vacua of a reduced moduli space. This allows us to obtain the distribution of observable parameters for inflation in this mini-landscape directly from the fluxes.

  14. Smoke inhalation injury

    NASA Astrophysics Data System (ADS)

    Birky, M.

    The cause of death by fires was studied. The present results and information are, however, not enough to reduce loss of life or inhalation injury. The magnitude and type of inhalation injury for civilians and firefighters represents the most inadequately defined human element of accidental fires. Little information is available on compounds other than carbon monoxide, which are responsible for respiration injury or toxicological syndrome. Effective treatment methods for inhalation victims and studies on fatalities, inhalation injury and animals are suggested.

  15. The characterization and evaluation of accidental explosions

    NASA Technical Reports Server (NTRS)

    Strehlow, R. A.; Baker, W. E.

    1975-01-01

    Accidental explosions are discussed from a number of viewpoints. First, all accidental explosions, intentional explosions and natural explosions are characterized by type. Second, the nature of the blast wave produced by an ideal (point source or HE) explosion is discussed to form a basis for describing how other explosion processes yield deviations from ideal blast wave behavior. The current status blast damage mechanism evaluation is also discussed. Third, the current status of our understanding of each different category of accidental explosions is discussed in some detail.

  16. Age-related macular degeneration.

    PubMed

    Lim, Laurence S; Mitchell, Paul; Seddon, Johanna M; Holz, Frank G; Wong, Tien Y

    2012-05-05

    Age-related macular degeneration is a major cause of blindness worldwide. With ageing populations in many countries, more than 20% might have the disorder. Advanced age-related macular degeneration, including neovascular age-related macular degeneration (wet) and geographic atrophy (late dry), is associated with substantial, progressive visual impairment. Major risk factors include cigarette smoking, nutritional factors, cardiovascular diseases, and genetic markers, including genes regulating complement, lipid, angiogenic, and extracellular matrix pathways. Some studies have suggested a declining prevalence of age-related macular degeneration, perhaps due to reduced exposure to modifiable risk factors. Accurate diagnosis combines clinical examination and investigations, including retinal photography, angiography, and optical coherence tomography. Dietary anti-oxidant supplementation slows progression of the disease. Treatment for neovascular age-related macular degeneration incorporates intraocular injections of anti-VEGF agents, occasionally combined with other modalities. Evidence suggests that two commonly used anti-VEGF therapies, ranibizumab and bevacizumab, have similar efficacy, but possible differences in systemic safety are difficult to assess. Future treatments include inhibition of other angiogenic factors, and regenerative and topical therapies.

  17. Age-related macular degeneration

    PubMed Central

    Coleman, Hanna R; Chan, Chi-Chao; Ferris, Frederick L; Chew, Emily Y

    2008-01-01

    Age-related macular degeneration is the leading cause of blindness in elderly populations of European descent. The most consistent risk factors associated with this ocular condition are increasing age and cigarette smoking. Genetic investigations have shown that complement factor H, a regulator of the alternative complement pathway, and LOC387715/HtrA1 are the most consistent genetic risk factors for age-related macular degeneration. Although the pathogenesis of this disease is unknown, oxidative stress might have an important role. Treatment with antioxidant vitamins and zinc can reduce the risk of developing advanced age-related macular degeneration by about a quarter in those at least at moderate risk. Intravitreal injections of ranibizumab, a monoclonal antibody that inhibits all forms of vascular endothelial growth factor, have been shown to stabilise loss of vision and, in some cases, improve vision in individuals with neovascular age-related macular degeneration. These findings, combined with assessments of possible environmental and genetic interactions and new approaches to modulate inflammatory pathways, will hopefully further expand our ability to understand and treat age-related macular degeneration. PMID:19027484

  18. Idiopathic horseshoe-like macular tear: a case report

    PubMed Central

    Kubota, Masaomi; Shibata, Tomohiro; Gunji, Hisato; Tsuneoka, Hiroshi

    2016-01-01

    Background Although a few cases with idiopathic horseshoe-like macular tear have been reported, the mechanism remains unknown and a standard treatment has yet to be determined. Objective To report the outcome for a patient with idiopathic horseshoe-like macular tear who underwent vitreous surgery. Case report A 65-year-old man with no previous injury or ophthalmic disease presented with abnormal vision in his left eye. Best-corrected visual acuity was 0.8 in the right and 0.3 in the left, and the relative afferent pupillary defect was negative. Ophthalmoscopy revealed a horseshoe-like tear on the temporal side of the macula in the left eye. The tear size was 0.75 disc diameters (DD). Optical coherence tomography showed that the focal retinal detachment reached the fovea. A few days after the first visit, there was no longer adhesion of the flap of the tear to the retina and the tear size had increased to 1.5 DD. The patient underwent vitreous surgery similar to large macular hole surgery, with the tear closure repaired using the inverted internal limiting membrane flap technique with 20% SF6 gas tamponade. Although the tear decreased to 0.5 DD after the surgery, complete closure of the tear was not achieved. Conclusion While cases with horseshoe-like macular tear following trauma and branch retinal vein occlusion have been reported, to the best of our knowledge, this is the first reported idiopathic case. In the present case, there was expansion of the tear until the patient actually underwent surgery. If vertical vitreous traction indeed plays a role in horseshoe-like macular tears, this will need to be taken into consideration at the time of the vitreous surgery in these types of cases. PMID:27555798

  19. Accidental separation and lodgment of rotary endodontic file into the dentist's thumb.

    PubMed

    Karnik, Rohit; Shetty, Subraj; Desai, Rajiv S; Shetty, Karthick

    2016-01-01

    Separation of the endodontic instrument within the root canal system and sharp injuries to the dentist is not an uncommon event in endodontic practice. Although root canal instruments can fracture at any stage of endodontic treatment, its fracture within the dentist's hand is a very rare event. An unusual case of accidental separation and lodgment of rotary endodontic file in the dentist's thumb is presented along with its management. A 33-year-old dentist reported with an accidental lodgment of rotary endodontic file into his thumb. The fractured instrument was removed successfully by a surgeon. The present case describes a rare event of occupational risk in endodontic practice.

  20. Spiral tibial fractures of children: a commonly accidental spiral long bone fracture.

    PubMed

    Mellick, L B; Reesor, K

    1990-05-01

    Pediatric training in child abuse has consistently emphasized a strong association between nonaccidental injuries and spiral fractures of long bones. Isolated spiral tibial fractures of childhood have previously been recognized by the orthopedic specialty to most frequently be accidental in etiology. The authors present evidence that supports a predominantly accidental etiology for isolated spiral tibial fractures of young children. This article presents a series in which 9 of 10 such spiral fractures were most likely the result of an accident and not child abuse or gross neglect. Additionally, almost all of these fractures presented as a gait disturbance and should be included in the differential of this complaint.

  1. [Age related macular degeneration].

    PubMed

    Sayen, Alexandra; Hubert, Isabelle; Berrod, Jean-Paul

    2011-02-01

    Age-related macular degeneration (ARMD) is a multifactorial disease caused by a combination of genetic and environmental factors. It is the first cause of blindness in patients over 50 in the western world. The disease has been traditionally classified into early and late stages with dry (atrophic) and wet (neovascular) forms: neovascular form is characterized by new blood vessels development under the macula (choroidal neovascularisation) which lead to a rapid decline of vision associated with metamorphopsia and requiring an urgent ophtalmological examination. Optical coherence tomography is now one of the most important part of the examination for diagnosis and treatment. Patient with age related maculopathy should consider taking a dietary supplement such that used in AREDS. The treatment of the wet ARMD has largely beneficied since year 2006 of anti-VEGF (vascular endothelial growth factor) molecules such as ranibizumab or bevacizumab given as repeated intravitreal injections. A systematic follow up each 4 to 8 week in required for several years. There is no effective treatment at the moment for dry AMD. For patients with binocular visual acuity under 60/200 rehabilitation includes low vision specialist, vision aids and psychological support.

  2. 5 CFR 870.206 - Accidental death and dismemberment.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 5 Administrative Personnel 2 2014-01-01 2014-01-01 false Accidental death and dismemberment. 870....206 Accidental death and dismemberment. (a)(1) Accidental death and dismemberment coverage is an automatic part of Basic and Option A insurance for employees. (2) There is no accidental death and...

  3. 5 CFR 870.206 - Accidental death and dismemberment.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 5 Administrative Personnel 2 2012-01-01 2012-01-01 false Accidental death and dismemberment. 870....206 Accidental death and dismemberment. (a)(1) Accidental death and dismemberment coverage is an automatic part of Basic and Option A insurance for employees. (2) There is no accidental death and...

  4. 5 CFR 870.206 - Accidental death and dismemberment.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 5 Administrative Personnel 2 2013-01-01 2013-01-01 false Accidental death and dismemberment. 870....206 Accidental death and dismemberment. (a)(1) Accidental death and dismemberment coverage is an automatic part of Basic and Option A insurance for employees. (2) There is no accidental death and...

  5. 5 CFR 870.206 - Accidental death and dismemberment.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 5 Administrative Personnel 2 2011-01-01 2011-01-01 false Accidental death and dismemberment. 870....206 Accidental death and dismemberment. (a)(1) Accidental death and dismemberment coverage is an automatic part of Basic and Option A insurance for employees. (2) There is no accidental death and...

  6. 5 CFR 870.206 - Accidental death and dismemberment.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Accidental death and dismemberment. 870....206 Accidental death and dismemberment. (a) (1) Accidental death and dismemberment coverage is an automatic part of Basic and Option A insurance for employees. (2) There is no accidental death...

  7. Diabetic macular edema.

    PubMed

    Stefánsson, Einar

    2009-07-01

    A variety of treatment options are available for the treatment of diabetic macular edema. They include laser photocoagulation, anti-VEGF drugs, intravitreal steroids, and vitrectomy with or without release of vitreoretinal traction. A full understanding of the physiological mechanisms of these treatment modalities allows sensible combination of treatment options. Retinal photocoagulation has repeatedly been shown to improve retinal oxygenation, as does vitrectomy. Oxygen naturally reduces VEGF production and thereby decreases leakage of plasma proteins from capillaries into the tissue. In addition, vitrectomy allows faster clearance of cytokines, such as VEGF, from the retina into the vitreous cavity. The VEGF-lowering effect of photocoagulation and vitrectomy can be augmented with anti-VEGF drugs and corticosteroids reduce the effect of VEGF on capillary permeability. Starling's law explains vasogenic edema, which is controlled by osmotic and hydrostatic gradients between vessel and tissue. It explains how VEGF-induced vascular permeability causes plasma protein to leak into the tissue interstitial space, thus decreasing the osmotic pressure gradient between vessel and tissue, resulting in water accumulation, i.e. edema. This is reversed by reducing VEGF production, which is achieved with laser treatment; or by removing VEGF with antibodies or vitrectomy; or by reducing the permeability effect with steroids. At the same time, Starling's law takes into account hemodynamic changes that affect the hydrostatic gradient. High arterial blood pressure and hypoxic vasodilatation increase the hydrostatic pressure in the microcirculation, which increases water flux from vessel to tissue and induce edema. Treatment of arterial hypertension or reversal of retinal hypoxia with laser reverses this pathophysiology and reduces edema. Newton's third law explains, that vitreoretinal traction decreases hydrostatic tissue pressure in the retina, increases the pressure gradient

  8. Macular posterior pigmentary incontinence: its relation to macular amyloidosis and notalgia paresthetica.

    PubMed

    Westermark, P; Ridderström, E; Vahlquist, A

    1996-07-01

    Patients with clinical features of dorsal macular amyloidosis but without subepidermal amyloid deposits were followed for 2-11 years. The clinical appearance was fairly stable during this period of time, with little tendency of healing. Only 2 of the patients developed typical macular amyloidosis during the follow-up. It is concluded that a condition strongly resembling macular amyloidosis but without amyloid is an entity, and the designation "macular posterior pigmentary incontinence" is proposed. The relationship between macular posterior pigmentary incontinence and the two conditions macular amyloidosis and notalgia paresthetica is discussed.

  9. Use of an Intravitreal Dexamethasone Implant (Ozurdex) in a Case with Accidental Foveal Photocoagulation by Alexandrite Laser.

    PubMed

    Bulut, Muhammed Nurullah; Çallı, Ümit; Göktaş, Eren; Bulut, Kezban; Kandemir, Baran; Özertürk, Yusuf

    2016-01-01

    Alexandrite laser is one of the most common methods of hair removal. Its utilization is gradually increasing due to easy accessibility and high effectiveness. However, the disuse of protective goggles during the application of this laser is a serious problem. In this case report, we presented a 35-year-old male patient who had foveal injury by alexandrite laser. The inflammatory process secondary to the foveal injury and subsequent macular edema were treated with Ozurdex because of its potent antiedematous effect.

  10. Uveitic Macular Edema: Treatment Update

    PubMed Central

    Goldhardt, Raquel; Rosen, Bradley Simon

    2016-01-01

    The aim of this review is to summarize recent developments in the treatment of uveitic macular edema (ME). ME represent a major cause of visual loss in uveitis and adequate management is crucial for the maintenance of useful vision in patients with chronic uveitis. PMID:27347446

  11. Age-Related Macular Degeneration.

    PubMed

    Mehta, Sonia

    2015-09-01

    Age-related macular degeneration (AMD) is the leading cause of vision loss in the elderly. AMD is diagnosed based on characteristic retinal findings in individuals older than 50. Early detection and treatment are critical in increasing the likelihood of retaining good and functional vision. Copyright © 2015 Elsevier Inc. All rights reserved.

  12. Genetics Home Reference: age-related macular degeneration

    MedlinePlus

    ... Health Conditions age-related macular degeneration age-related macular degeneration Printable PDF Open All Close All Enable Javascript ... view the expand/collapse boxes. Description Age-related macular degeneration is an eye disease that is a leading ...

  13. South Dakota accidental childhood deaths, 2000-2007: what can we do?

    PubMed

    Svien, Lana R; Senne, Svien A; Rasmussen, Carl

    2010-05-01

    Unintentional injuries are the leading cause of death in children around the world and are an under-recognized public health problem in the United States. The purpose of this study was to highlight the nature of the problem in South Dakota and outline interventions that have been successful in reducing childhood injuries in other states. This quantitative retrospective study examined mortality files in South Dakota for children birth to 19 years of age who died between January 1, 2000 to December 28, 2007. Although the number of deaths declined considerably from 2006 to 2007, South Dakota had the second-highest rate in the nation of childhood unintentional injury deaths from all causes between 2000-2005. The majority of deaths occurred in males and were associated with transportation-related deaths. Suffocation was the leading cause of death for newborns to age 1 year. Childhood accidental death in South Dakota is clearly a critical public health problem. Intervention efforts to reduce deaths from unintentional injuries amongst children should be targeted as the leading causes of accidental death for specific age groups and American Indian youth. Physicians, health educators and policymakers must play a role in prevention targeting the high-risk groups in addition to advocating for policy changes to protect childhood safety. More stringent child restraint laws, graduated driving laws, smoking cessation programs for parents, creation of safer sleep environments and further investigation of why a high proportion of American Indian children die accidentally in South Dakota are all warranted.

  14. Coroners' records of accidental deaths.

    PubMed Central

    Levene, S

    1991-01-01

    This study set out to provide a description of the children involved in fatal accidents and to ascertain which deaths might have been prevented and by what means. The records from a convenience sample of four coroners (jurisdictions of Inner North London, Birmingham, Bedfordshire, and Ipswich) of inquests opened in 1984-8 on children aged under 15 killed in accidents were reviewed for information on the deceased, the accident, and the injuries sustained. Altogether 225 records (150 boys, 75 girls) were examined. Accidents to pedestrians were the commonest cause of death (81 cases), and road safety engineering measures were the most likely means by which most fatalities might have been prevented. The records frequently omitted information on social circumstances, family structure, ethnic group, or the use of safety equipment. Cooperative coroners can contribute to child safety as their records are rich in information about accidents. This could be made available to parties interested in accident prevention, including community paediatricians. PMID:1953011

  15. [Smartphone-operated detonation of a firecracker resulting in a macular hole].

    PubMed

    Papazoglou, A; Baumüller, S; Meyer, C

    2014-11-01

    A 22-year-old man presented to the emergency room on New Years Eve after a firecracker had exploded next to his left eye. Besides injuries to the eyelid, conjunctival and corneal trauma, a commotio retinae at the temporal periphery and the central retina were revealed funduscopically. A small full macular hole was detected by spectral domain optical coherence tomography scan (OCT). After topical treatment with tobramycin, fluorometholone and lubrication eye drops the best-corrected vision improved from 0.2 to 0.8 within 3 months and the follow-up OCT revealed a spontaneous closure of the macular hole.

  16. Accidental degeneracies in nonlinear quantum deformed systems

    NASA Astrophysics Data System (ADS)

    Aleixo, A. N. F.; Balantekin, A. B.

    2011-09-01

    We construct a multi-parameter nonlinear deformed algebra for quantum confined systems that includes many other deformed models as particular cases. We demonstrate that such systems exhibit the property of accidental pairwise energy level degeneracies. We also study, as a special case of our multi-parameter deformation formalism, the extension of the Tamm-Dancoff cutoff deformed oscillator and the occurrence of accidental pairwise degeneracy in the energy levels of the deformed system. As an application, we discuss the case of a trigonometric Rosen-Morse potential, which is successfully used in models for quantum confined systems, ranging from electrons in quantum dots to quarks in hadrons.

  17. Deep accidental hypothermia during the Queensland summer.

    PubMed

    Udy, Andrew A; Ziegenfuss, Marc D; Fraser, John F

    2007-12-01

    A 52-year-old woman presented with severe accidental hypothermia associated with out-of-hospital cardiac arrest after a polypharmacy overdose. Deep hypothermia developed while she lay unconscious, with a split-system air-conditioning unit rapidly cooling the confined area of her bedroom. Despite the need for lengthy resuscitative efforts at the scene and in hospital, she went on to a full neurological recovery. The neuroprotective role of accidental hypothermia is reviewed, as are the guidelines for resuscitation in this setting. We conclude that hypothermia must be considered even in unlikely circumstances, such as the Queensland summer, when ambient temperatures are high.

  18. Spontaneous closure of traumatic macular holes.

    PubMed

    Faghihi, Hooshang; Ghassemi, Fariba; Falavarjani, Khalil Ghasemi; Saeedi Anari, Ghasem; Safizadeh, Mona; Shahraki, Kourosh

    2014-08-01

    To present a series of cases with spontaneous closure of traumatic macular hole. Case series. Six eyes of 6 patients with traumatic macular hole. The characteristics of eyes with macular hole secondary to blunt trauma in which the macular hole closed spontaneously without surgical manipulation were reviewed. Patient age range was 13 to 55 years. There were 4 full-thickness and 2 lamellar macular holes. Spontaneous closure occurred after 1 to 6 months of observation. Best corrected visual acuity improved in 5 eyes and remained unchanged in the other eye. Spontaneous closure of traumatic macular holes may occur within 6 months after initial presentation. Copyright © 2014 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.

  19. Macular thickness and macular volume measurements using spectral domain optical coherence tomography in normal Nepalese eyes

    PubMed Central

    Pokharel, Amrit; Shrestha, Gauri Shankar; Shrestha, Jyoti Baba

    2016-01-01

    Purpose To record the normative values for macular thickness and macular volume in normal Nepalese eyes. Methods In all, 126 eyes of 63 emmetropic subjects (mean age: 21.17±6.76 years; range: 10–37 years) were assessed for macular thickness and macular volume, using spectral domain-optical coherence tomography over 6×6 mm2 in the posterior pole. A fast macular thickness protocol was employed. Statistics such as the mean, median, standard deviation, percentiles, and range were used, while a P-value was set at 0.05 to test significance. Results Average macular thickness and total macular volume were larger in males compared to females. With each year of increasing age, these variables decreased by 0.556 μm and 0.0156 mm3 for average macular thickness and total macular volume, respectively. The macular thickness was greatest in the inner superior section and lowest at the center of the fovea. The volume was greatest in the outer nasal section and thinnest in the fovea. The central subfield thickness (r=−0.243, P=0.055) and foveal volume (r=0.216, P=0.09) did not correlate with age. Conclusion Males and females differ significantly with regard to macular thickness and macular volume measurements. Reports by other studies that the increase in axial length reduced thickness and volume, were negated by this study which found a positive correlation among axial length, thickness, and volume. PMID:27041990

  20. [Therapeutic approach in persistent diabetic macular edema].

    PubMed

    Brănişteanu, Daniel; Moraru, Andreea

    2014-01-01

    Terminology of persistent diabetic macular edema has been initially reserved to cases unresponsive to conventional laser photocoagulation according to ETDRS criteria. While knowledge about pathophysiology of macular edema evolved and new drugs became available, the terminology of persistent diabetic macular edema expanded to include resistance to most current therapies. The purpose of this paper is to review medical and surgical options in the treatment of such difficult cases according to literature data and personal experience.

  1. [Pathogenesis of age-related macular degeneration].

    PubMed

    Kaarniranta, Kai; Seitsonen, Sanna; Paimela, Tuomas; Meri, Seppo; Immonen, Ilkka

    2009-01-01

    Age-related macular degeneration is a multiform disease of the macula, the region responsible for detailed central vision. In recent years, plenty of new knowledge of the pathogenesis of this disease has been obtained, and the treatment of exudative macular degeneration has greatly progressed. The number of patients with age-related macular degeneration will multiply in the following decades, because knowledge of mechanisms of development of macular degeneration that could be subject to therapeutic measures is insufficient. Central underlying factors are genetic inheritance, exposure of the retina to chronic oxidative stress and accumulation of inflammation-inducing harmful proteins into or outside of retinal cells.

  2. Non-accidental trauma: the role of radiology.

    PubMed

    Pfeifer, Cory M; Hammer, Matthew R; Mangona, Kate L; Booth, Timothy N

    2017-04-01

    Non-accidental trauma is a significant source of morbidity and mortality in the pediatric population. Given the vulnerable state of the child, the radiologist can often provide valuable diagnostic information in the setting of suspected abuse. This review focuses on common findings of abusive trauma and serves as a guide to aid in clinical decision-making for providers of emergency medicine and pediatrics. Amid this discussion is an assessment of modern controversies regarding reported mimicking pathologies, recapitulation of the current state of evidence with respect to radiologic findings of abuse, and examination of the contribution that spine imaging may add to the diagnosis of possible abusive head trauma in the acutely injured child. Recommendations for avoiding pitfalls regarding the dating of intracranial injuries are discussed, and illustrated depictions of perpetrator-induced pathology are provided to aid in the understanding of these injuries. Through the use of the appropriate approach to imaging and evidence-based guidelines regarding radiologic findings, the role of radiology is to provide fundamental clues to diagnose and prevent recurrence of abusive injury in patients who cannot speak for themselves.

  3. Accidental bilateral Q-switched neodymium laser exposure: treatment and recovery of visual function

    NASA Astrophysics Data System (ADS)

    Zwick, Harry; Stuck, Bruce E.; Dunlap, Weldon; Scales, David K.; Lund, David J.; Ness, James W.

    1998-05-01

    A 21 year old female was accidentally exposed in both eyes when she looked into the 10 cm exit aperture of a military laser designator emitting 1064 nm q-switched (30 ns) pulses at a 10 pulse per second rate. Steroid therapy (methylprednisolone sodium succinate) was initiated within 6 hours post exposure. Initial ophthalmoscopic observation revealed small contained macular hemorrhages in each eye. Fluorescein angiography (FA) showed minimal leakage. Visual acuity was 20/100 and 20/60 in OD and OS respectively. Contrast sensitivity in both eyes was depressed across all spatial frequencies by more than 1.5 log units. At four weeks post exposure, no significant macular scarring was apparent and visual acuity returned to 20/25 in both eyes. Contrast sensitivity had improved to normal levels with a peak at 3 cycles/degree. At one year post exposure, visual acuity was 20/13 in both eyes and measures of contrast sensitivity were within normal limits. During the course of recovery, the patient's fixation shifted from a slightly superior temporal site back to the central foveal region. The foveal lesion sites were still evident by ophthalmoscopy and Amsler grid measurements but were deemed functional when the patient placed small targets generated by the scanning laser ophthalmoscope in the lesion site for discrimination. This outcome indicates remarkable recovery of visual function and suggests that early administration of steroids may assist in preserving the natural neural recovery process of the photoreceptor matrix by minimizing intraretinal scar formation.

  4. Accidental subretinal brilliant blue G migration during internal limiting membrane peeling surgery.

    PubMed

    Almeida, Felipe P P; De Lucca, Ana Claudia; Scott, Ingrid Ursula; Jorge, Rodrigo; Messias, Andre

    2015-01-01

    This case report describes a man who developed retinal changes in his right eye associated with brilliant blue G migration into the subretinal space during 2 years of follow-up. The patient's best-corrected visual acuity in the right eye was 20/70 before surgery, and it improved to 20/25 at 1 year after surgery. Fluorescein angiography showed staining during the late phase in the central macula at all follow-up visits after surgery. Multifocal electroretinography demonstrated normal amplitude and implicit times before surgery but decreased amplitudes and increased implicit times in at least 5 contiguous hexagons after surgery on all 3 examinations performed during the 2-year follow-up period. These functional changes were not topographically correlated with the area of fluorescein staining or with the internal limiting membrane peeled area, but were matched to the area where brilliant blue G accidentally entered the subretinal space. Microperimetry demonstrated reduced retinal threshold sensitivity, particularly in areas with decreased multifocal electroretinography amplitude. Despite the visual acuity improvement observed in this case, multifocal electroretinography and microperimetry indicate that subretinal brilliant blue G might cause focal macular damage with a decrease of macular function suggestive of a toxic effect.

  5. Accidental death of elderly persons under the influence of chlorpheniramine.

    PubMed

    Suzuki, Hideto; Shigeta, Akio; Fukunaga, Tatsushige

    2013-09-01

    Older individuals are susceptible to accident, such as falls, some of which are fatal. In such cases, autopsies and toxicological analysis may be deemed unnecessary, especially if the critical injuries and manner of death can be determined conclusively based on information at the scene and an external investigation. Here, we report the results of two autopsies performed on elderly individuals who died accidentally under the influence of chlorpheniramine. These autopsies revealed valuable additional information. Case 1: A woman in her 70s, who was living alone, was found dead under the stairs in her house. She had no history of a condition that could have led to sudden death. The autopsy revealed a neck fracture, multiple rib fractures, and a coccyx fracture. The histopathological findings showed fat embolisms in numerous small vessels of the interalveolar septum. Toxicological analysis of blood samples revealed the presence of chlorpheniramine (0.41μg/ml). Case 2: A woman in her 70s, who was living alone, was found dead in the bathtub in her house. There was no past medical history other than diabetes mellitus and vertigo. The autopsy revealed hyper-inflated lungs and brown-red fluids in the trachea, but there was no evidence of a pathology or injury that could have induced a loss of consciousness. Toxicological analysis of the fluids in the right thoracic cavity revealed the presence of chlorpheniramine (0.57μg/ml). In both cases, re-examination of the scene after the autopsy revealed the presence of common cold medicine containing chlorpheniramine. The victim may have accidentally overdosed on common cold medicine. This overdose would have been compounded by anti-histamine-induced drowsiness. The present cases suggest that forensic pathologists should always notify physicians/pharmacists of findings pertaining to unexpected drug side effects. Such intervention would prevent many accidental deaths. In addition, each autopsy must be performed in conjunction with

  6. Accidental Datura stramonium poisoning in a dog.

    PubMed

    Tostes, Raimundo A

    2002-02-01

    Datura stramonium is potentially poisonous to humans and livestock; however, there's little description of clinical and pathological findings in dogs naturally intoxicated. We report an accidental Datura stramonium poisoning in a dog emphasizing the importance of recognizing the classical signs of anticholinergic poisoning.

  7. Vitrectomy for idiopathic macular hole.

    PubMed

    Parravano, Mariacristina; Giansanti, Fabrizio; Eandi, Chiara M; Yap, Yew C; Rizzo, Stanislao; Virgili, Gianni

    2015-05-12

    A macular hole is an anatomic opening in the retina that develops at the fovea. Macular holes can be seen in highly myopic eyes or following ocular trauma, but the great majority are idiopathic. Pars plana vitrectomy was introduced to treat full-thickness macular holes, which if left untreated have a poor prognosis since spontaneous closure and visual recovery are rare.Vitrectomy is a surgical technique involving the removal of the vitreous body that fills the eye. The surgeon inserts thin cannulas into the eyes through scleral incisions to relieve traction exerted by the vitreous or epiretinal membranes to the central retina and to induce glial tissue to bridge and close the hole. The primary objective of this review was to examine the effects of vitrectomy for idiopathic macular hole on visual acuity. A secondary objective was to investigate anatomic effects on hole closure and other dimensions of visual function, as well as to report on adverse effects recorded in included studies. We searched the Cochrane Eyes and Vision Group Trials Register (4 March 2015), the Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 2), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to March 2015), EMBASE (January 1980 to March 2015), Latin American and Caribbean Health Sciences Literature Database (LILACS) (January 1982 to March 2015), the Web of Science Conference Proceedings Citation Index-Science (CPCI-S) (January 1980 to March 2015), the ISRCTN registry (www.isrctn.com/editAdvancedSearch), ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 4 March 2015. We included randomised controlled trials comparing vitrectomy (with or without

  8. 21 CFR 1002.20 - Reporting of accidental radiation occurrences.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Reporting of accidental radiation occurrences... SERVICES (CONTINUED) RADIOLOGICAL HEALTH RECORDS AND REPORTS Manufacturers' Reports on Accidental Radiation Occurrences § 1002.20 Reporting of accidental radiation occurrences. (a) Manufacturers of electronic products...

  9. 21 CFR 1002.20 - Reporting of accidental radiation occurrences.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Reporting of accidental radiation occurrences... SERVICES (CONTINUED) RADIOLOGICAL HEALTH RECORDS AND REPORTS Manufacturers' Reports on Accidental Radiation Occurrences § 1002.20 Reporting of accidental radiation occurrences. (a) Manufacturers of electronic products...

  10. 21 CFR 1002.20 - Reporting of accidental radiation occurrences.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Reporting of accidental radiation occurrences... SERVICES (CONTINUED) RADIOLOGICAL HEALTH RECORDS AND REPORTS Manufacturers' Reports on Accidental Radiation Occurrences § 1002.20 Reporting of accidental radiation occurrences. (a) Manufacturers of electronic products...

  11. 21 CFR 1002.20 - Reporting of accidental radiation occurrences.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Reporting of accidental radiation occurrences... SERVICES (CONTINUED) RADIOLOGICAL HEALTH RECORDS AND REPORTS Manufacturers' Reports on Accidental Radiation Occurrences § 1002.20 Reporting of accidental radiation occurrences. (a) Manufacturers of electronic products...

  12. 21 CFR 1002.20 - Reporting of accidental radiation occurrences.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Reporting of accidental radiation occurrences... SERVICES (CONTINUED) RADIOLOGICAL HEALTH RECORDS AND REPORTS Manufacturers' Reports on Accidental Radiation Occurrences § 1002.20 Reporting of accidental radiation occurrences. (a) Manufacturers of electronic products...

  13. The genetics of inherited macular dystrophies

    PubMed Central

    Michaelides, M; Hunt, D; Moore, A

    2003-01-01

    The aim of this paper is to review current knowledge relating to the monogenic macular dystrophies, with discussion of currently mapped genes, chromosomal loci and genotype-phenotype relationships. Inherited systemic disorders with a macular dystrophy component will not be discussed. PMID:12960208

  14. Correlations Between Macular, Skin, and Serum Carotenoids

    PubMed Central

    Conrady, Christopher D.; Bell, James P.; Besch, Brian M.; Gorusupudi, Aruna; Farnsworth, Kelliann; Ermakov, Igor; Sharifzadeh, Mohsen; Ermakova, Maia; Gellermann, Werner; Bernstein, Paul S.

    2017-01-01

    Purpose Ocular and systemic measurement and imaging of the macular carotenoids lutein and zeaxanthin have been employed extensively as potential biomarkers of AMD risk. In this study, we systematically compare dual wavelength retinal autofluorescence imaging (AFI) of macular pigment with skin resonance Raman spectroscopy (RRS) and serum carotenoid levels in a clinic-based population. Methods Eighty-eight patients were recruited from retina and general ophthalmology practices from a tertiary referral center and excluded only if they did not have all three modalities tested, had a diagnosis of macular telangiectasia (MacTel) or Stargardt disease, or had poor AFI image quality. Skin, macular, and serum carotenoid levels were measured by RRS, AFI, and HPLC, respectively. Results Skin RRS measurements and serum zeaxanthin concentrations correlated most strongly with AFI macular pigment volume under the curve (MPVUC) measurements up to 9° eccentricity relative to MPVUC or rotationally averaged macular pigment optical density (MPOD) measurements at smaller eccentricities. These measurements were reproducible and not significantly affected by cataracts. We also found that these techniques could readily identify subjects taking oral carotenoid-containing supplements. Conclusions Larger macular pigment volume AFI and skin RRS measurements are noninvasive, objective, and reliable methods to assess ocular and systemic carotenoid levels. They are an attractive alternative to psychophysical and optical methods that measure MPOD at a limited number of eccentricities. Consequently, skin RRS and MPVUC at 9° are both reasonable biomarkers of macular carotenoid status that could be readily adapted to research and clinical settings. PMID:28728169

  15. Correlations Between Macular, Skin, and Serum Carotenoids.

    PubMed

    Conrady, Christopher D; Bell, James P; Besch, Brian M; Gorusupudi, Aruna; Farnsworth, Kelliann; Ermakov, Igor; Sharifzadeh, Mohsen; Ermakova, Maia; Gellermann, Werner; Bernstein, Paul S

    2017-07-01

    Ocular and systemic measurement and imaging of the macular carotenoids lutein and zeaxanthin have been employed extensively as potential biomarkers of AMD risk. In this study, we systematically compare dual wavelength retinal autofluorescence imaging (AFI) of macular pigment with skin resonance Raman spectroscopy (RRS) and serum carotenoid levels in a clinic-based population. Eighty-eight patients were recruited from retina and general ophthalmology practices from a tertiary referral center and excluded only if they did not have all three modalities tested, had a diagnosis of macular telangiectasia (MacTel) or Stargardt disease, or had poor AFI image quality. Skin, macular, and serum carotenoid levels were measured by RRS, AFI, and HPLC, respectively. Skin RRS measurements and serum zeaxanthin concentrations correlated most strongly with AFI macular pigment volume under the curve (MPVUC) measurements up to 9° eccentricity relative to MPVUC or rotationally averaged macular pigment optical density (MPOD) measurements at smaller eccentricities. These measurements were reproducible and not significantly affected by cataracts. We also found that these techniques could readily identify subjects taking oral carotenoid-containing supplements. Larger macular pigment volume AFI and skin RRS measurements are noninvasive, objective, and reliable methods to assess ocular and systemic carotenoid levels. They are an attractive alternative to psychophysical and optical methods that measure MPOD at a limited number of eccentricities. Consequently, skin RRS and MPVUC at 9° are both reasonable biomarkers of macular carotenoid status that could be readily adapted to research and clinical settings.

  16. What Is Age-Related Macular Degeneration?

    MedlinePlus

    ... To Protect Against Macular Degeneration Jan 27, 2016 Eye Exercises May Improve Vision Around Blind Spot Sep 29, 2015 Could Stem Cells Cure Blindness Caused by Macular Degeneration? Sep 29, 2015 Fighting the Signs of Aging? Don’t Forget the Eyes Sep 11, ... Follow The Academy Professionals: Education ...

  17. US infant mortality trends attributable to accidental suffocation and strangulation in bed from 1984 through 2004: are rates increasing?

    PubMed

    Shapiro-Mendoza, Carrie K; Kimball, Melissa; Tomashek, Kay M; Anderson, Robert N; Blanding, Sarah

    2009-02-01

    Accidental suffocation and strangulation in bed, a subgroup of sudden, unexpected infant deaths, is a leading mechanism of injury-related infant deaths. We explored trends and characteristics of these potentially preventable deaths. In this descriptive study, we analyzed US infant mortality data from 1984 through 2004. To explore trends in accidental suffocation and strangulation in bed and other sudden, unexpected infant deaths, we calculated cause-specific infant mortality rates and estimated proportionate mortality. Sudden, unexpected infant death was defined as a combination of all deaths attributed to accidental suffocation and strangulation in bed, sudden infant death syndrome, and unknown causes. Finally, we examined factors that were reported as contributing to these accidental suffocation and strangulation in bed deaths. Between 1984 and 2004, infant mortality rates attributed to accidental suffocation and strangulation in bed increased from 2.8 to 12.5 deaths per 100000 live births. These rates remained relatively stagnant between 1984 and 1992 and increased between 1992 and 2004; the most dramatic increase occurred between 1996 and 2004 (14% average annual increase). In contrast, total sudden, unexpected infant death rates remained stagnant between 1996 and 2004, whereas the proportion of deaths attributed to sudden infant death syndrome declined and to unknown cause increased. Black male infants <4 months of age were disproportionately affected by accidental suffocation and strangulation in bed. Beds, cribs, and couches were reported as places where deaths attributed to accidental suffocation and strangulation in bed occurred. Infant mortality rates attributable to accidental suffocation and strangulation in bed have quadrupled since 1984. The reason for this increase is unknown. Prevention efforts should target those at highest risk and focus on helping parents and caregivers provide safer sleep environments.

  18. Keratoconus in Patients with Macular Stromal Dystrophy.

    PubMed

    Kosrirukvongs, Panida; Ngowyutagon, Panotsom; Booranapong, Wipawee

    2016-01-01

    To show the association between keratoconus and macular dystrophy. All patients with macular dystrophy and associated clinical findings leading to a diagnosis of keratoconus by corneal topography were retrospectively reviewed during a 10-year period. Uncorrected and best-corrected visual acuity, automated refraction, manifest refraction, corneal thickness, and corneal curvature by corneal topography were evaluated Three patients with macular dystrophy exhibiting decreased vision, multifocal white dense deposits, and haze surrounding the deposits in the corneal stroma were evaluated. All had a steep corneal curvature of >47 diopters and a thin cornea consistent with keratoconus. Penetrating keratoplasty was performed in one patient with severely decreased vision. Macular dystrophy was diagnosed based on an Alcian blue-stained pathological specimen. Keratoconus may develop as a result of changes associated with macular dystrophy. Therefore, patients with severely decreased vision should be evaluated for keratoconus to ensure proper management.

  19. Fatal acute intoxication of accidentally ingested nifedipine in an infant - A case report.

    PubMed

    Yamamoto, Hiroki; Takayasu, Tatsunori; Nosaka, Mizuho; Kimura, Akihiko; Ishida, Yuko; Kawaguchi, Takashi; Fukami, Mie; Okada, Misato; Kondo, Toshikazu

    2017-01-01

    A fatal case of acute nifedipine intoxication in a two-year-old boy is presented. The boy accidentally orally ingested an unknown amount of his grandfather's nifedipine (40mg/tablet), mistaking it for a ramune confectionery. Despite intensive medical treatment, his death was confirmed at 31h after the accidental ingestion. The forensic autopsy revealed that there were neither pathological alterations or injuries in all of the organs. Toxicologically, nifedipine could be detected at the concentrations of 0.463, 0.669 and 13.0μg/g in cardiac blood, peripheral blood and stomach contents, respectively. These concentrations were evaluated as fatal levels, and the cause of death was diagnosed as acute nifedipine intoxication. Recently, the number of infants and children who accidentally ingest drugs in the home is increasing. This case report prompts forensic pathologists and toxicologists to emphasize that children are always exposed to the risk of accidental drug ingestion in daily life. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  20. ‘Toy' laser macular burns in children

    PubMed Central

    Raoof, N; Chan, T K J; Rogers, N K; Abdullah, W; Haq, I; Kelly, S P; Quhill, F M

    2014-01-01

    Purpose Laser ‘toys' can be purchased online and imported with relative ease; the variety of such devices is a potential public safety concern. We describe five children with maculopathy following exposure to laser ‘toys'. Methods Case series of maculopathy following exposure to laser ‘toys'. Results Five children were seen in our Ophthalmic Unit with macular injuries following exposure to laser ‘toys'. Clinically, three children had an acute vitelliform-like maculopathy which resolved to leave sub-foveal retinal pigment epithelium changes with reduced vision. One case was complicated by a choroidal neovascular membrane. Conclusion Laser ‘toys', which resemble laser pointers, are increasingly available over the internet. Such ‘toys' may not meet safety standards. Retinal injury in childhood following exposure to laser ‘toys' is a public safety concern. PMID:24434663

  1. Association of age-related macular degeneration and reticular macular disease with cardiovascular disease.

    PubMed

    Rastogi, Neelesh; Smith, R Theodore

    2016-01-01

    Age-related macular degeneration is the leading cause of adult blindness in the developed world. Thus, major endeavors to understand the risk factors and pathogenesis of this disease have been undertaken. Reticular macular disease is a proposed subtype of age-related macular degeneration correlating histologically with subretinal drusenoid deposits located between the retinal pigment epithelium and the inner segment ellipsoid zone. Reticular lesions are more prevalent in females and in older age groups and are associated with a higher mortality rate. Risk factors for developing age-related macular degeneration include hypertension, smoking, and angina. Several genes related to increased risk for age-related macular degeneration and reticular macular disease are also associated with cardiovascular disease. Better understanding of the clinical and genetic risk factors for age-related macular degeneration and reticular macular disease has led to the hypothesis that these eye diseases are systemic. A systemic origin may help to explain why reticular disease is diagnosed more frequently in females as males suffer cardiovascular mortality at an earlier age, before the age of diagnosis of reticular macular disease and age-related macular degeneration. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. Fatal accidental inhalation of bromochlorodifluoromethane (Halon 1211).

    PubMed

    Lerman, Y; Winkler, E; Tirosh, M S; Danon, Y; Almog, S

    1991-03-01

    Bromochlorodifluoromethane (Halon 1211) is a widely used fire extinguishing agent. Several cases of sudden death in teenagers associated with BCF abuse have been reported. BCF is used as a fire extinguisher in battle tanks. Two young previously healthy male soldiers were accidentally exposed to BCF in a battle tank. The tank driver died, but the gunner survived the event with no medial complications. It is concluded that BCF should be used in confined chambers only after the evacuation of all personnel.

  3. Carcinoid Tumor in Accidental, Asymptomatic Meckel's Diverticulum.

    PubMed

    Baranyai, Zsolt; Jósa, Valeria; Merkel, Keresztely; Zolnai, Zsofia

    2013-01-01

    Although Meckel's diverticulum is the most common congenital gastrointestinal disorder, it is controversial whether asymptomatic diverticula in adults should be respected. The authors report the case of a patient who was operated due to ileus caused by adhesions and a Meckel's diverticulum without any sign of inflammation was accidentally noted and removed. As a surprise, the pathological examination of the diverticulum proved carcinoid tumor, a neuroendocrine malignant tumor. The case raises the importance of the removal of asymptomatic Meckel's diverticulum.

  4. Carcinoid Tumor in Accidental, Asymptomatic Meckel's Diverticulum

    PubMed Central

    Baranyai, Zsolt; Jósa, Valeria; Merkel, Keresztely; Zolnai, Zsofia

    2013-01-01

    Although Meckel's diverticulum is the most common congenital gastrointestinal disorder, it is controversial whether asymptomatic diverticula in adults should be respected. The authors report the case of a patient who was operated due to ileus caused by adhesions and a Meckel's diverticulum without any sign of inflammation was accidentally noted and removed. As a surprise, the pathological examination of the diverticulum proved carcinoid tumor, a neuroendocrine malignant tumor. The case raises the importance of the removal of asymptomatic Meckel's diverticulum. PMID:24470856

  5. [Macular diseases in the elderly person].

    PubMed

    Matsui, M

    1989-09-01

    Macular diseases in the elderly, such as age-related macular degeneration, idiopathic senile macular hole and epiretinal membrane of the macular area were studied. In 75 normal subjects aged from 20 to 78 years, retinal sensitivity in the central 10 degree visual field were examined using automated static quantitative perimetry. For background luminance of 31.5 asb, a significant reciprocal correlation was demonstrated between individual mean sensitivity and age. The influence of age on the decrease in sensitivity was proved to differ according to different test locations. To enhance contrast, an image processing procedure was applied for fluorescein angiographs of age-related pathologies which resulted in better recognition of age-related RPE pathologies were recognized. The senile disciform macular degeneration (SDMD) study group sponsored by the Ministry of Health and Welfare performed an epidemiological survey to estimate the number of patients with SDMD. The epidemiological estimation was 6,000 to 13,000 patients in the entire Japanese population. 133 eyes of uni- or bi-lateral senile macular degeneration without choroidal neovascularization and 156 opposite eyes of patients with unilateral SDMD were followed-up for choroidal neovascularization development. Choroidal neovascularization development was confirmed in 15 eyes, 5.2%. In 13 of the 15 eyes, choroidal neovascularization was proved to develop through serous RPE detachment. Also, serous drusen were shown to be to predisposed to choroidal neovascularization through serous RPE detachment. Therefore, it was concluded that senile macular degeneration should be classified into the atrophic form, predisciform or intermediate form and disciform form. In the author's previous paper, it was reported that the navel-like lesion would be a macular lesion predisposing to a senile macular hole. 49 opposite eye of patients with one eye affected by a macular hole were follow-up for macular hole development. At the

  6. Age-related macular degeneration

    PubMed Central

    Querques, Giuseppe; Avellis, Fernando Onofrio; Querques, Lea; Bandello, Francesco; Souied, Eric H

    2011-01-01

    Clinical question: Is there any new knowledge about the pathogenesis and treatment of age-related macular degeneration (AMD)? Results: We now understand better the biochemical and pathological pathways involved in the genesis of AMD. Treatment of exudative AMD is based on intravitreal injection of new antivascular endothelial growth factor drugs for which there does not yet exist a unique recognized strategy of administration. No therapies are actually available for atrophic AMD, despite some experimental new pharmacological approaches. Implementation: strategy of administration, safety of intravitreal injection PMID:21654887

  7. [Age-related macular degeneration].

    PubMed

    Budzinskaia, M V

    2014-01-01

    The review provides an update on the pathogenesis and new treatment modalities for neovascular age-related macular degeneration (AMD). The impact of polymorphism in particular genes, including complement factor H (CFH), age-related maculopathy susceptibility 2 (ARMS2/LOC387715), and serine peptidase (HTRA1), on AMD development is discussed. Clinical presentations of different forms of exudative AMD, that is classic, occult, or more often mixed choroidal neovascularization, retinal angiomatous proliferation, and choroidal polypoidal vasculopathy, are described. Particular attention is paid to the results of recent clinical trials and safety issues around the therapy.

  8. Diabetic Macular Edema: From Old Concepts to New Therapeutic Avenues.

    PubMed

    Mansour, Ahmad M; Pulido, Jose S; Arevalo, J Fernando

    2015-01-01

    Diabetic macular edema (DME) is a significant cause of blindness in the working population and is currently challenging to treat. Current interventions include focal laser or intravitreal injections. This article outlines a new treatment protocol based on the theory that peripheral ischemia is the precursor to angiogenesis, which will ultimately gather its momentum at the fovea. Extreme peripheral light laser panretinal photocoagulation (PRP) back to the equator reduces excessive production of the vascular endothelial growth factor (VEGF) in the eye. This decreases VEGF-induced DME and provides long-term protection against the development of neovascularization. Initial exacerbation of DME often accompanies PRP. Therefore, injections of anti-VEGF agents (with or without dexamethasone implants) initially can forestall worsening of DME and prevent loss of vision. However, on the other hand, applying peripheral PRP and intraocular injections can induce posterior vitreous detachment (PVD). This could help release vitreomacular adhesions (VMA) and vitreomacular traction (VMT), thereby decreasing DME severity and improving the response to intravitreal injections. In the current approach, peripheral retinal photocoagulation should stop the drive for VEGF release; moreover, laser ablation should produce secondary, accidental, and beneficial PVD. This approach precludes focal laser therapy and paves the path for prolonged intervals between anti-VEGF therapy.

  9. Accidental Strangulation Due to Entrapment of Saree in Crop Thrasher Machine in an Elderly Women Working at Agricultural Field.

    PubMed

    Parchake, Manoj Bhausaheb; Kumre, Vikas; Kachare, Rajesh V

    2016-09-01

    Strangulation is generally considered as homicidal death and in accidental strangulation circumstantial evidence alone can point toward the accidental nature of incidence. In present case, a 71-year-old woman, wearing a saree (garment worn by traditional women in India) working in agricultural field, got entangled in the crop thrasher machine and got strangled. Immediately, she was taken to the nearest hospital, where she survived for 6 to 8 hours and then died. The autopsy reveals cross ribbon-shaped ligature mark on neck and anterior chest along with 1 puncture wound at the right lateral aspect of the neck. A lack of proper precaution and safety measures at agricultural field are other contributing factors. Accidental strangulation by saree is extremely rare, hence, this case is presented for its rarity and pattern of injury.

  10. [Effects of diabetes mellitus on the occurrence of age-related macular degeneration].

    PubMed

    Li, Xia; Wang, Yu-sheng

    2011-03-01

    Diabetes mellitus causing long term disturbed glucose metabolism could result in tissue injury and multiple complications. According to recent studies, diabetes mellitus might be regarded as one of the risk factors of age related macular degeneration (AMD). Diabetes mellitus affects the incidence and progression of AMD through altering hemodynamics, increasing oxidative stress, accumulating advanced glycation end products, etc. By studying epidemiological investigation and basic research on this subject comprehensively, it is required to review the correlation between diabetes mellitus and AMD.

  11. Cold injuries.

    PubMed

    Long, William B; Edlich, Richard F; Winters, Kathryne L; Britt, L D

    2005-01-01

    Exposure to cold can produce a variety of injuries that occur as a result of man's inability to adapt to cold. These injuries can be divided into localized injury to a body part, systemic hypothermia, or a combination of both. Body temperature may fall as a result of heat loss by radiation, evaporation, conduction, and convection. Hypothermia or systemic cold injury occurs when the core body temperature has decreased to 35 degrees C (95 degrees F) or less. The causes of hypothermia are either primary or secondary. Primary, or accidental, hypothermia occurs in healthy individuals inadequately clothed and exposed to severe cooling. In secondary hypothermia, another illness predisposes the individual to accidental hypothermia. Hypothermia affects multiple organs with symptoms of hypothermia that vary according to the severity of cold injury. The diagnosis of hypothermia is easy if the patient is a mountaineer who is stranded in cold weather. However, it may be more difficult in an elderly patient who has been exposed to a cold environment. In either case, the rectal temperature should be checked with a low-reading thermometer. The general principals of prehospital management are to (1) prevent further heat loss, (2) rewarm the body core temperature in advance of the shell, and (3) avoid precipitating ventricular fibrillation. There are two general techniques of rewarming--passive and active. The mechanisms of peripheral cold injury can be divided into phenomena that affect cells and extracellular fluids (direct effects) and those that disrupt the function of the organized tissue and the integrity of the circulation (indirect effects). Generally, no serious damage is seen until tissue freezing occurs. The mildest form of peripheral cold injury is frostnip. Chilblains represent a more severe form of cold injury than frostnip and occur after exposure to nonfreezing temperatures and damp conditions. Immersion (trench) foot, a disease of the sympathetic nerves and blood

  12. Anaphylaxis after accidental ingestion of kiwi fruit

    PubMed Central

    Różalska, Anna; Ukleja-Sokołowska, Natalia; Żbikowska-Gotz, Magdalena; Bartuzi, Zbigniew

    2013-01-01

    Numerous cases of anaphylaxis after ingestion of kiwi fruit, after the skin tests and during oral immunotherapy were described. The article describes the case of severe anaphylactic reaction that occurred in a 55-year-old patient after accidental ingestion of kiwi. Allergy to kiwi fruit was confirmed by a native test with fresh kiwi fruit. After the test, the patient experienced generalized organ response in the form of headache, general weakness and rashes on the neck and breast, and dyspnea. The patient had significantly elevated levels of total IgE and IgE specific to kiwi fruit. PMID:24278073

  13. Accidental Kähler moduli inflation

    SciTech Connect

    Maharana, Anshuman; Rummel, Markus; Sumitomo, Yoske

    2015-09-14

    We study a model of accidental inflation in type IIB string theory where inflation occurs near the inflection point of a small Kähler modulus. A racetrack structure helps to alleviate the known concern that string-loop corrections may spoil Kähler Moduli Inflation unless having a significant suppression via the string coupling or a special brane setup. Also, the hierarchy of gauge group ranks required for the separation between moduli stabilization and inflationary dynamics is relaxed. The relaxation becomes more significant when we use the recently proposed D-term generated racetrack model.

  14. Accidental Kähler moduli inflation

    SciTech Connect

    Maharana, Anshuman; Rummel, Markus; Sumitomo, Yoske E-mail: markus.rummel@physics.ox.ac.uk

    2015-09-01

    We study a model of accidental inflation in type IIB string theory where inflation occurs near the inflection point of a small Kähler modulus. A racetrack structure helps to alleviate the known concern that string-loop corrections may spoil Kähler Moduli Inflation unless having a significant suppression via the string coupling or a special brane setup. Also, the hierarchy of gauge group ranks required for the separation between moduli stabilization and inflationary dynamics is relaxed. The relaxation becomes more significant when we use the recently proposed D-term generated racetrack model.

  15. Accidental swallowing of orthodontic expansion appliance key.

    PubMed

    Monini, André da Costa; Maia, Luiz Guilherme Martins; Jacob, Helder Baldi; Gandini, Luiz Gonzaga

    2011-08-01

    Ingestion of a foreign object, including a dental object, can lead to a trip to the emergency room. This article describes the accidental swallowing of a key that was used to activate a rapid maxillary expander. An orthodontic patient swallowed the key while trying to activate the appliance at home. The object's trajectory was followed on radiographs until it was eliminated. Possible clinical complications, legal implications of this situation, and practices for prevention are described. Copyright © 2011 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.

  16. Accidental poisoning with biodiesel preservative biocide

    PubMed Central

    Aslanidis, T; Ourailoglou, V; Boultoukas, E; Giannakou-Peftoulidou, M

    2014-01-01

    Although biodiesel fuels’ use is getting more and more popular, there are only few reports in the literature of poisoning with such agents, and none referring to their preservatives: biocides. We present the management of a 49-year-old Caucasian male who was admitted, after accidental ingestion of biocide solution, in the intensive care unit of a tertiary hospital. In spite of his devastating condition upon arrival to the hospital, he had a remarkable recovery with no local or systemic sequel due to multidisciplinary and early supportive approach of his care. PMID:25336882

  17. Anaphylaxis after accidental ingestion of kiwi fruit.

    PubMed

    Gawrońska-Ukleja, Ewa; Różalska, Anna; Ukleja-Sokołowska, Natalia; Zbikowska-Gotz, Magdalena; Bartuzi, Zbigniew

    2013-06-01

    Numerous cases of anaphylaxis after ingestion of kiwi fruit, after the skin tests and during oral immunotherapy were described. The article describes the case of severe anaphylactic reaction that occurred in a 55-year-old patient after accidental ingestion of kiwi. Allergy to kiwi fruit was confirmed by a native test with fresh kiwi fruit. After the test, the patient experienced generalized organ response in the form of headache, general weakness and rashes on the neck and breast, and dyspnea. The patient had significantly elevated levels of total IgE and IgE specific to kiwi fruit.

  18. Ground Shock Effects from Accidental Explosions

    DTIC Science & Technology

    1976-11-01

    2,640 2.47 x 10_1+ Limestone 2,400 2.25 x 10ŕ* Sandstone 2,240 2.10 x 10_l+ Shale 2,320 2.17 x 10-*4 Concrete 2,400 2.25 x 10ŕ* 19 Table 4...and compact soils Sandstone and cemented soils Shale and marl Limestone-chalk Metamorphic rocks Volcanic rocks Sound plutonic rocks Jointed...Accidental Explosions," Dept. of the Army Technical Manual TM 5-1300 (also NAVFAC P-397, AFM 88-22), Washington, DC, June 1969. 2. R. E. Crawford

  19. [Macular coloboma type Leber's congenital amaurosis].

    PubMed

    Kiratli, H; Bozkurt, B

    2002-01-01

    Three brothers, with the macular coloboma type Leber's congenital amaurosis aged 10, 8, and 6 years respectively, are described in this report. Only the two elder brothers were symptomatic while the third patient had no complaint at the time of diagnosis. The patients had no associated systemic or ocular disorders, including nystagmus. They had mild myopic astigmatism. All three had a relatively well-circumscribed bilateral macular atrophy with a seemingly normal peripheral retina. The electroretinogram was non recordable but the visualy evoked potential responses were within normal limits. During three years of follow-up, the macular lesions did not progress and the visual acuity did not deteriorate further. Our experience with these three familial cases supports the general view that the macular coloboma variant does not necessarily have the typical signs and symptoms and perhaps also the dismal prognosis of classic Leber's congenital amaurosis, and as such should stand as a distinct subtype of the disease.

  20. Genetics Home Reference: vitelliform macular dystrophy

    MedlinePlus

    ... faces. Vitelliform macular dystrophy causes a fatty yellow pigment (lipofuscin) to build up in cells underlying the ... structures in these cells that contain light-sensing pigments. It is unclear why PRPH2 mutations affect only ...

  1. Flicker fusion thresholds in Best macular dystrophy.

    PubMed

    Massof, R W; Fleischman, J A; Fine, S L; Yoder, F

    1977-06-01

    Flicker fusion threshold intensities were measured as a function of flicker frequency for patients with Best macular dystrophy having normal or near-normal Snellen visual acuity. These data were found to differ from normal in ways that may be interpreted to be an abnormal elevation of the foveal cone threshold, a loss of cone temporal resolution, or both. The results led to the conclusion that Best macular dystrophy affects the neurosensory retina even when Snellen visual acuity is normal.

  2. Overview of diabetic macular edema.

    PubMed

    Holekamp, Nancy M

    2016-07-01

    Diabetes mellitus (DM) is a rapidly growing epidemic in the United States, and it is expected to affect 592 million individuals within the next 20 years. Diabetic retinopathy (DR) and diabetic macular edema (DME) are the 2 most common ophthalmic complications of DM. DR is the leading cause of blindness among working-age adults around the world, and development of DR is tied to DM disease duration. With the only identifier of early markers of DR being a complete ophthalmic exam, early signs of the disease are asymptomatic. Yearly, or at least every other year, ophthalmic exams are recommended for all patients with DM; but often, individuals with DM have not undergone screening exams and do not have regular eye exams until vision loss has occurred. With spending estimates of $490 million to treat the vision complications of DM, it is clear that DR and DME impose a substantial burden for patients, caregivers, and healthcare systems.

  3. Macular edema: definition and basic concepts.

    PubMed

    Coscas, Gabriel; Cunha-Vaz, José; Soubrane, Gisèle

    2010-01-01

    Macular edema is the result of an accumulation of fluid in the retinal layers around the fovea. It contributes to vision loss by altering the functional cell relationship in the retina and promoting an inflammatory reparative response. Macular edema may be intracellular or extracellular. Intracellular accumulation of fluid, also called cytotoxic edema, is an alteration of the cellular ionic distribution. Extracellular accumulation of fluid, which is more frequent and clinically more relevant, is directly associated with an alteration of the blood-retinal barrier (BRB). The following parameters are relevant for clinical evaluation of macular edema: extent of the macular edema (i.e., the area that shows increased retinal thickness); distribution of the edema in the macular area (i.e., focal versus diffuse macular edema); central foveal involvement (central area 500 microm); fluorescein leakage (evidence of alteration of the BRB or 'open barrier') and intraretinal cysts; signs of ischemia (broken perifoveolar capillary arcade and/or areas of capillary closure); presence or absence of vitreous traction; increase in retinal thickness and cysts in the retina (inner or outer), and chronicity of the edema (i.e., time elapsed since initial diagnosis and response to therapy). It is essential to establish associations and correlations of all the different images obtained, regardless of whether the same or different modalities are used.

  4. Macular pigment and lutein supplementation in choroideremia.

    PubMed

    Duncan, Jacque L; Aleman, Tomas S; Gardner, Leigh M; De Castro, Elaine; Marks, Daniel A; Emmons, Jessica M; Bieber, Michelle L; Steinberg, Janet D; Bennett, Jean; Stone, Edwin M; MacDonald, Ian M; Cideciyan, Artur V; Maguire, Maureen G; Jacobson, Samuel G

    2002-03-01

    Choroideremia is an incurable X-linked retinal degeneration caused by mutations in the gene encoding Rab escort protein-1. A group of clinically defined and genotyped patients were studied to determine: (1) the degree of rod and cone dysfunction and structural abnormality in the central retina and the level of macular pigment; and (2) the response of macular pigment and foveal vision to a 6 month trial of supplementation with oral lutein (at 20 mg per day). Rod and cone-mediated function was measured with dark-adapted static perimetry; in vivo retinal structure was determined with optical coherence tomography; and macular pigment optical density was measured with heterochromatic flicker photometry. In this cohort of patients (ages 15-65 years), both rod- and cone-mediated central function declined with age as did central retinal thickness. Macular pigment levels did not differ between patients and male control subjects. Supplementation of oral lutein in a subset of patients led to an increase in serum lutein and macular pigment levels; absolute foveal sensitivity did not change. It is concluded that macular pigment density can be augmented by oral intake of lutein in patients with choroideremia. There was no short-term change in the central vision of the patients on the supplement, but long-term influences of lutein supplementation on disease natural history warrant further study.

  5. Population-based incidence of macular holes.

    PubMed

    McCannel, Colin A; Ensminger, Jennifer L; Diehl, Nancy N; Hodge, David N

    2009-07-01

    To determine the incidence of full-thickness macular holes in Olmsted County, Minnesota. Population-based retrospective chart review (cross-sectional study). Ninety-four eyes of 85 patients who were residents of Olmsted County, Minnesota. A population-based retrospective chart review was performed for all diagnoses of macular hole between 1992 and 2002 among residents of Olmsted County, Minnesota. Yearly incidence rates for each given age and sex group were determined by dividing the number of cases within that group by the estimated total Olmsted County resident population of the group for that given year. Documented clinical diagnosis of a macular hole. Idiopathic macular holes occur at an age- and sex-adjusted incidence in 7.8 persons and 8.69 eyes per 100,000 population per year in Olmsted County, Minnesota. The female-to-male ratio was determined to be 3.3 to 1, and bilateral idiopathic macular holes occurred in 11.7% of patients and accounted for 20.9% of the affected eyes. This study uniquely determined the incidence of macular holes in a predominantly Caucasian population.

  6. Use of an Intravitreal Dexamethasone Implant (Ozurdex) in a Case with Accidental Foveal Photocoagulation by Alexandrite Laser

    PubMed Central

    Bulut, Muhammed Nurullah; Çallı, Ümit; Göktaş, Eren; Bulut, Kezban; Kandemir, Baran; Özertürk, Yusuf

    2016-01-01

    Alexandrite laser is one of the most common methods of hair removal. Its utilization is gradually increasing due to easy accessibility and high effectiveness. However, the disuse of protective goggles during the application of this laser is a serious problem. In this case report, we presented a 35-year-old male patient who had foveal injury by alexandrite laser. The inflammatory process secondary to the foveal injury and subsequent macular edema were treated with Ozurdex because of its potent antiedematous effect. PMID:27293415

  7. Chloracne from the accidental production of tetrachlorodibenzodioxin

    PubMed Central

    May, George

    1973-01-01

    May, G. (1973).British Journal of Industrial Medicine,30, 276-283. Chloracne from the accidental production of tetrachlorodibenzodioxin. Following the accidental production of 2,3,7,8-tetrachlorodibenzodioxin (dioxin) as the result of an exothermic reaction at a chemical plant in Derbyshire, 79 cases of chloracne were recorded, many of them severe. Contrary to the usual experience they have responded very favourably to treatment and there were no cases of contact chloracne among relatives or domestic animals in the initial outbreak. However, two cases of contact chloracne were recorded three years later. Similar incidents are known to have occured in both Europe and the United States of America, almost invariably accompanied by widespread severe illness and with fatalities. Apart from one death due to an explosion which followed the exothermic reaction the more serious sequelae, which may range from depression and loss of weight to liver, kidney, and cardiac failure as well as malignant disease, have not occurred. A quick and reliable method of biological assay for the presence of dioxin in produced trichlorophenol was developed based on oral dosage to rabbits with assessment of liver function at fixed time intervals thereafter. This test has already been superseded by instantaneous gas-liquid chromatography. An entirely new plant with suitable modifications and multiple safety features has now been in satisfactory operation for three years. Images PMID:4269256

  8. Classification of full-thickness traumatic macular holes by optical coherence tomography.

    PubMed

    Huang, Jingjing; Liu, Xing; Wu, Ziqiang; Lin, Xiaofeng; Li, Mei; Dustin, Laurie; Sadda, Srinivas

    2009-03-01

    To describe morphologic features of traumatic macular holes on optical coherence tomography and to correlate them with clinical findings. Seventy-three consecutive patients diagnosed with full-thickness traumatic macular holes involving the fovea underwent complete ophthalmic evaluation followed by horizontal and vertical line scans using the Stratus optical coherence tomography. Retinal thickness at the edges of the holes, apical and basal diameters, and various clinical parameters were recorded. The approximate apical and basal areas and eccentricities of the holes were calculated. Morphologic parameters were correlated with clinical findings. On the basis of optical coherence tomography findings, traumatic macular holes were classified into five morphologic types with varying average retinal thicknesses, apical areas, and basal areas. Patients who presented >90 days after injury had greater average retinal thickness (P = 0.03) and apex areas (P = 0.002) compared with those who presented within 90 days. Older patients developed more circular holes, i.e., less eccentricity of the apex (P = 0.04) and base (P = 0.01). Interestingly, none of the morphologic parameters investigated in the current study correlated with visual acuity. Patients who presented later in the clinical course or who had greater average retinal thicknesses tended to have better vision (P = 0.11 and P = 0.07, respectively). Optical coherence tomography evaluation may yield important insights into the pathogenesis and clinical findings of traumatic macular holes.

  9. Macular thickness as a predictor of loss of visual sensitivity in ethambutol-induced optic neuropathy

    PubMed Central

    Peng, Chun-xia; Zhang, Ai-di; Chen, Bing; Yang, Bing-jian; Wang, Qiu-hong; Yang, Mo; Wei, Shi-hui

    2016-01-01

    Ethambutol is a common cause of drug-related optic neuropathy. Prediction of the onset of ethambutol-induced optic neuropathy and consequent drug withdrawal may be an effective method to stop visual loss. Previous studies have shown that structural injury to the optic nerve occurred earlier than the damage to visual function. Therefore, we decided to detect structural biomarkers marking visual field loss in early stage ethambutol-induced optic neuropathy. The thickness of peripapillary retinal nerve fiber layer, macular thickness and visual sensitivity loss would be observed in 11 ethambutol-induced optic neuropathy patients (22 eyes) using optical coherence tomography. Twenty-four healthy age- and sex-matched participants (48 eyes) were used as controls. Results demonstrated that the temporal peripapillary retinal nerve fiber layer thickness and average macular thickness were thinner in patients with ethambutol-induced optic neuropathy compared with healthy controls. The average macular thickness was strongly positively correlated with central visual sensitivity loss (r2 =0.878, P=0.000). These findings suggest that optical coherence tomography can be used to efficiently screen patients. Macular thickness loss could be a potential factor for predicting the onset of ethambutol-induced optic neuropathy. PMID:27127488

  10. [Skateboard injuries (author's transl)].

    PubMed

    Stürz, H; Rosemeyer, B

    1979-04-06

    Following the introduction of skateboards into Germany in 1976 an increasing number of accidents and injuries have been noted, affecting mainly children 10 to 14 years of age. The causes were lack of experience and the careless use of the boards on public streets. More than 30% of injuries were fractures mainly affecting the upper limb. Because of the frequent involvement of the epiphyseal plates the post-accidental growth may be seriously disturbed. Severe and sometimes fatal head or abdominal injuries have been reported, mainly after collision with cars.

  11. Accidental deaths caused by electricity in Sweden, 1975-2000.

    PubMed

    Lindström, Richard; Bylund, Per-Olof; Eriksson, Anders

    2006-11-01

    This study analyzes accidental fatalities caused by electricity--at work and during leisure time--to evaluate risk factors, the role of alcohol, and to identify possible preventive strategies. In Sweden, data on fatalities by electrocution from 1975 through 2000 were collected from the National Cause-of-Death Register. Additional cases were found in the archives of The Swedish National Electrical Safety Board. Suicides and deaths by lightning were excluded. Two hundred and eighty-five deaths were found, including occupational (n=132), leisure time (n=151), and unknown (n=2). Most deaths were caused by aerial power lines, and the most common place for an electrical injury was a railway area or residential property. Postmortem blood from 20% (n=47) of the tested cases was found positive for alcohol, and these persons were killed mainly during leisure time. During the study period, the overall incidence of electricity-related fatalities has decreased, in spite of increased use of electricity. This indicates that safety improvements have been successful.

  12. Acute macular neuroretinopathy associated with systemic lupus erythematosus.

    PubMed

    Lee, D H; Lee, S C; Kim, M

    2016-04-01

    Acute macular neuroretinopathy (AMN) is a rare disorder that presents with abrupt visual change with wedge-shaped or flower-like lesions pointing towards the fovea. Ischemic insults to the retinal capillary plexus may be important for development of this disease. While many case reports have been published on AMN, none have described AMN in association with systemic lupus erythematosus (SLE). Here, we report a case of AMN associated with newly-diagnosed SLE. We speculate that in patients with lupus flares, immune complex-mediated vascular injury and microvascular thrombosis may disrupt the deep retinal capillary network, causing ischemic damages to the outer retina and leading to the development of AMN. AMN can develop in patients with lupus flares, and must be considered as an SLE-associated ophthalmologic complication. To the best of our knowledge, this is the first case report of AMN associated with SLE.

  13. Course Management Systems for Learning: Beyond Accidental Pedagogy

    ERIC Educational Resources Information Center

    McGee, Patricia; Carmean, Colleen; Jafari, Ali

    2005-01-01

    "Course Management Systems for Learning: Beyond Accidental Pedagogy" is a comprehensive overview of standards, practices and possibilities of course management systems in higher education. "Course Management Systems for Learning: Beyond Accidental Pedagogy" focuses on what the current knowledge is (in best practices, research, standards and…

  14. Course Management Systems for Learning: Beyond Accidental Pedagogy

    ERIC Educational Resources Information Center

    McGee, Patricia; Carmean, Colleen; Jafari, Ali

    2005-01-01

    "Course Management Systems for Learning: Beyond Accidental Pedagogy" is a comprehensive overview of standards, practices and possibilities of course management systems in higher education. "Course Management Systems for Learning: Beyond Accidental Pedagogy" focuses on what the current knowledge is (in best practices, research, standards and…

  15. Experiences of Causing an Accidental Death: An Interpretative Phenomenological Analysis

    ERIC Educational Resources Information Center

    Rassool, Sara B.; Nel, Pieter W.

    2012-01-01

    Accidentally killing or feeling responsible for another person's death constitutes an event that is different from many typical traumatic stressors in that the responsibility for causing the trauma is located in the person themselves, rather than another person or persons. Research exploring the perspective of those who have accidentally caused a…

  16. Imitation of Intentional and Accidental Actions by Children with Autism

    ERIC Educational Resources Information Center

    D'Entremont, Barbara; Yazbek, Aimee

    2007-01-01

    To determine whether children with autism (CWA) would selectively imitate intentional, as opposed to accidental actions, an experimenter demonstrated either an "intentional" and an "accidental" action or two "intentional" actions on the same toy [Carpenter, Akhtar, & Tomasello ("1998a") "Infant Behavior and Development, 21," 315-330]. CWA tended…

  17. Experiences of Causing an Accidental Death: An Interpretative Phenomenological Analysis

    ERIC Educational Resources Information Center

    Rassool, Sara B.; Nel, Pieter W.

    2012-01-01

    Accidentally killing or feeling responsible for another person's death constitutes an event that is different from many typical traumatic stressors in that the responsibility for causing the trauma is located in the person themselves, rather than another person or persons. Research exploring the perspective of those who have accidentally caused a…

  18. 49 CFR 192.195 - Protection against accidental overpressuring.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 3 2011-10-01 2011-10-01 false Protection against accidental overpressuring. 192.195 Section 192.195 Transportation Other Regulations Relating to Transportation (Continued) PIPELINE... Pipeline Components § 192.195 Protection against accidental overpressuring. (a) General requirements...

  19. 10 CFR 70.52 - Reports of accidental criticality.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 2 2010-01-01 2010-01-01 false Reports of accidental criticality. 70.52 Section 70.52 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) DOMESTIC LICENSING OF SPECIAL NUCLEAR MATERIAL Special Nuclear Material Control, Records, Reports and Inspections § 70.52 Reports of accidental criticality. (a...

  20. 10 CFR 70.52 - Reports of accidental criticality.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 10 Energy 2 2013-01-01 2013-01-01 false Reports of accidental criticality. 70.52 Section 70.52 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) DOMESTIC LICENSING OF SPECIAL NUCLEAR MATERIAL Special Nuclear Material Control, Records, Reports and Inspections § 70.52 Reports of accidental criticality. (a...

  1. 10 CFR 70.52 - Reports of accidental criticality.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 10 Energy 2 2012-01-01 2012-01-01 false Reports of accidental criticality. 70.52 Section 70.52 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) DOMESTIC LICENSING OF SPECIAL NUCLEAR MATERIAL Special Nuclear Material Control, Records, Reports and Inspections § 70.52 Reports of accidental criticality. (a...

  2. 10 CFR 70.52 - Reports of accidental criticality.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 10 Energy 2 2014-01-01 2014-01-01 false Reports of accidental criticality. 70.52 Section 70.52 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) DOMESTIC LICENSING OF SPECIAL NUCLEAR MATERIAL Special Nuclear Material Control, Records, Reports and Inspections § 70.52 Reports of accidental criticality. (a...

  3. 10 CFR 70.52 - Reports of accidental criticality.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 10 Energy 2 2011-01-01 2011-01-01 false Reports of accidental criticality. 70.52 Section 70.52 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) DOMESTIC LICENSING OF SPECIAL NUCLEAR MATERIAL Special Nuclear Material Control, Records, Reports and Inspections § 70.52 Reports of accidental criticality. (a...

  4. Non-accidental trauma in pediatric patients: a review of epidemiology, pathophysiology, diagnosis and treatment.

    PubMed

    Paul, Alexandra R; Adamo, Matthew A

    2014-07-01

    Non-accidental trauma (NAT) is a leading cause of childhood traumatic injury and death in the United States. It is estimated that 1,400 children died from maltreatment in the United States in 2002 and abusive head trauma (AHT) accounted for 80% of these deaths. This review examines the epidemiology and risk factors for NAT as well as the general presentation and required medical work up of abused children. In addition, potential algorithms for recognizing cases of abuse are reviewed as well as outcomes in children with NAT and potential neurosurgical interventions which may be required. Finally, the evidence for seizure prophylaxis in this population is addressed.

  5. Rickettsial infection caused by accidental conjunctival inoculation

    PubMed Central

    Brissos, Joao; de Sousa, Rita; Santos, Ana Sofia; Gouveia, Catarina

    2015-01-01

    The most common transmission route of tick-borne Rickettsia is through tick bite; nevertheless, other transmission routes should also be considered. We report a case of rickettsial infection in a 15-year-old boy caused by accidental contamination of the conjunctiva through the infected fluid of a crushed engorged tick removed from a dog. Right eye pain, conjunctival hyperaemia with mucopurulent exudate, chemosis and eyelid oedema were the first signs and symptoms. Two days later, the boy developed fever, myalgia, headache, abdominal pain and was vomiting; physical examination showed multiple cervical adenopathies but no rash. He was treated with doxycycline (200 mg/day) for 7 days with progressive resolution of clinical signs. Rickettsial infection was confirmed by immunofluorescence assay with serological seroconversion in two consecutive samples. Rickettsia conorii or Rickettsia massiliae were the possible causal agents since they are the Rickettsia spp found in the Rhipicephalus sanguineus dog tick in Portugal. PMID:25568272

  6. Accidental Turbulent Discharge Rate Estimation from Videos

    NASA Astrophysics Data System (ADS)

    Ibarra, Eric; Shaffer, Franklin; Savaş, Ömer

    2015-11-01

    A technique to estimate the volumetric discharge rate in accidental oil releases using high speed video streams is described. The essence of the method is similar to PIV processing, however the cross correlation is carried out on the visible features of the efflux, which are usually turbulent, opaque and immiscible. The key step in the process is to perform a pixelwise time filtering on the video stream, in which the parameters are commensurate with the scales of the large eddies. The velocity field extracted from the shell of visible features is then used to construct an approximate velocity profile within the discharge. The technique has been tested on laboratory experiments using both water and oil jets at Re ~105 . The technique is accurate to 20%, which is sufficient for initial responders to deploy adequate resources for containment. The software package requires minimal user input and is intended for deployment on an ROV in the field. Supported by DOI via NETL.

  7. Preventing and controlling accidental gas releases

    NASA Astrophysics Data System (ADS)

    Moskowitz, P. D.; Fthenakis, V. M.; Kalb, P. D.

    1988-07-01

    Toxic, flammable, and explosive gases may be used in photovoltaic cell research laboratories and in commercial manufacturing facilities. Accidental release of these materials can present hazards to life and property. Accidents can arise from a variety of mechanical and human related failures. These can occur from the time materials are received at the loading dock of the facility to the time treated gases are discharged to the atmosphere through a stack. Each type of initiating event may require a different control approach. These may range from the training and certification of plant workers charged with the handling of gas cylinder hookups to installation of emergency pollution control systems. Since engineering options for controlling released materials are limited, emphasis should be placed on administrative and engineering approaches for preventing such accidents. These are likely to be the most effective approaches for protecting life and property.

  8. Accidental Deaths Among British Columbia Indians

    PubMed Central

    Schmitt, N.; Hole, L. W.; Barclay, W. S.

    1966-01-01

    A statistical and epidemiological review of British Columbia native Indian and non-Indian mortality revealed that accidents were the leading cause of death among Indians but ranked only fourth among non-Indians. Comparison of accidental death rates by age and sex showed that, without exception, the rates among Indians were considerably higher than the corressponding rates for non-Indians. While the Indians represented some 2% of the total population of British Columbia, they accounted for over 10% of the total accident fatalities, 29% of drownings, and 21% of fatal burns. Socioeconomic, environmental and psychosocial factors and excessive drinking are considered the chief causes responsible for this rather unusual epidemiological phenomenon. This study revealed certain hazardous conditions which are specific to the Indian's present way of life. In the authors' opinion the recognition of these specific hazards is imperative for the planning of effective preventive campaigns. PMID:5902238

  9. Techniques for preventing accidental damage to pipelines

    SciTech Connect

    Lothon, A.; Akel, S.

    1996-12-31

    Following a survey of all of the techniques capable of preventing third-party damage to its gas transmission pipelines, Gaz de France has selected two of them, Electromagnetic Detection and Positioning by Satellite. The first technique is based on detection of the magnetic field existing around transmission pipes excited by a driving current. A receiver is mounted on the excavation equipment to detect the magnetic field, thereby preventing any risk of hitting the pipe. The second technique consists in locating excavators by satellite. Each excavator needs to be equipped with a GPS beacon to know its position. Using the map of the transmission network stored in data-base form, i.e., digitized, the system calculates the position of the excavator relative to the pipes buried in its vicinity so as to avoid any accidental contact. The main features, advantages and drawbacks of the two techniques are presented in this paper.

  10. Reduce accidental releases of hazardous materials

    SciTech Connect

    Ledbetter, D.

    1996-09-01

    With final publication of the Risk Management Program (RMP), operating companies must take action to lessen the likelihood of accidental hazardous chemical releases. Now, companies must extensively investigate how raw materials and products are managed within the process and storage facilities. Protection at high costs is not profitable. At the same time, not enough protection is also costly should a release invoke substantial property damage or loss of life. Modern ways to confine regulated compounds include inherently safer technologies (ISTs) and active mitigation technologies. These new designs and added options can improve protection against more likely release scenarios. Using the guidelines, HPI operators manage both compliance and cost of compliance when developing safety programs for RMP.

  11. Accidental Contamination with Oil during Endodontic Surgery.

    PubMed

    Plascencia, Hugo; Díaz, Mariana; Cholico, Patricia; Del Real, Monserrat; Márquez-de Alba, Salvador

    2016-01-01

    The modern surgical endodontic treatment is a safe and predictable procedure with high success rate. However, several factors can retard or impede the proper healing process. Use of a high speed handpiece during hard tissues management (osteotomy and apical resection) can potentially be one of these factors. Formation of metallic debris from the surgical diamond burs, production of necrotic local tissue due to overheating and the direct liberation of air from conventional handpiece into the working area are potential irritants able to delay the tissue healing. The aim of the present article is to report the histopathological findings of the trans-operational accidental contamination with oil in the surgical area during an endodontic surgery.

  12. Accidental Contamination with Oil during Endodontic Surgery

    PubMed Central

    Plascencia, Hugo; Díaz, Mariana; Cholico, Patricia; del Real, Monserrat; Márquez-de Alba, Salvador

    2016-01-01

    The modern surgical endodontic treatment is a safe and predictable procedure with high success rate. However, several factors can retard or impede the proper healing process. Use of a high speed handpiece during hard tissues management (osteotomy and apical resection) can potentially be one of these factors. Formation of metallic debris from the surgical diamond burs, production of necrotic local tissue due to overheating and the direct liberation of air from conventional handpiece into the working area are potential irritants able to delay the tissue healing. The aim of the present article is to report the histopathological findings of the trans-operational accidental contamination with oil in the surgical area during an endodontic surgery. PMID:27790269

  13. Accidental cell phone ingestion with pharyngeal impaction.

    PubMed

    Ali, Mohammed M; Bahl, Kazal; Dross, Matthew; Farooqui, Shoheb; Dross, Peter

    2014-09-01

    35 year old intoxicated male ingested an unusual, large foreign object (cell phone). To report the ingestion of an unusual large foreign object with hypopharyngeal impaction, complications, and treatment. Foreign body ingestion in the adult population is more prevalent in those who engage in drug or alcohol abuse. Impaction and perforation of the upper aerodigestive tract can lead to significant and potentially fatal complications including parapharyngeal/retropharyngeal abscess, mediastinitis, and aortoesophageal fistula. The treatment of foreign object ingestion is dependent on the type of foreign object ingested, its location, and potential for perforation. Endoscopic removal under general anesthesia is the treatment method recommended for foreign bodies impacted at the cricopharyngeus or esophagus. We report the only case of the accidental ingestion of an entire cell phone with casing. A plain film x-ray of the neck can be used in the assessment of the location of radiopaque foreign objects and in diagnosing potential complication.

  14. Management of macular epiretinal membrane by vitrectomy and intravitreal triamcinolone.

    PubMed

    Shukla, Dhananjay

    2014-04-01

    A patient underwent successful vitrectomy for macular epiretinal membrane with anatomical and functional improvement. 10 weeks later, there was a recurrence of macular edema with corresponding visual decline. An intravitreal injection of triamcinolone acetonide not only restored the macular anatomy but also improved the visual outcome beyond that achieved after surgery.

  15. Traumatic Penile Injury: From Circumcision Injury to Penile Amputation

    PubMed Central

    Park, Jae Young; Song, Yun Seob

    2014-01-01

    The treatment of external genitalia trauma is diverse according to the nature of trauma and injured anatomic site. The classification of trauma is important to establish a strategy of treatment; however, to date there has been less effort to make a classification for trauma of external genitalia. The classification of external trauma in male could be established by the nature of injury mechanism or anatomic site: accidental versus self-mutilation injury and penis versus penis plus scrotum or perineum. Accidental injury covers large portion of external genitalia trauma because of high prevalence and severity of this disease. The aim of this study is to summarize the mechanism and treatment of the traumatic injury of penis. This study is the first review describing the issue. PMID:25250318

  16. Macular translocation: histopathologic findings in swine eyes.

    PubMed

    Roig-Melo, E A; Afaro, D V; Heredia-Elizondo, M L; Yarbrough, L M; Game, A B; Apple, D J; Quirol, H M

    2000-01-01

    Macular translocation has been proposed as an alternative technique in the treatment of some cases of choroidal neovascularization. The purpose of the paper is to report the histopathologic findings in the retina of swine eyes undergone macular translocation. Ten eyes of ten Yucatan pigs underwent posterior pars plana vitrectomy and scleral imbrication to achieve macular translocation. Mattress sutures were preplaced at the equator of the eyes. After a pars plana vitrectomy, balanced saline solution was injected under the temporal retina to produce a retinal detachment. Scleral imbrication was achieved by tightening the mattress sutures. An air-fluid exchange was performed and the eye was filled with sulfur hexafluoride 18%. The eyes were enucleated 2, 4, 8 and 12 weeks after surgery and analyzed under light and electron microscopy. Macular translocation was achieved in all cases. The major findings consist of a minimal decrease in the number of photoreceptors outer segments; also a change in the morphology was noted. This included some degree of loss of vertical alignment and an increase in the interphotoreceptor space. There was a recovery in the morphology of the photoreceptors over time. Minimal changes in the photoreceptors and retinal pigment epithelium are observed when macular translocation is performed with recovery of these changes over time. Scleral imbrication is an effective technique to achieve translocation of the fovea.

  17. Surgical treatment of lamellar macular holes.

    PubMed

    Michalewska, Zofia; Michalewski, Janusz; Odrobina, Dominik; Pikulski, Zbigniew; Cisiecki, Sławomir; Dziegielewski, Krzysztof; Nawrocki, Jerzy

    2010-10-01

    The aim of this study is to present functional and anatomical results of pars plana vitrectomy without gas tamponade in lamellar macular holes. Additionally, the study determines factors influencing final outcome. Twenty-six eyes of 26 patients with lamellar macular hole were diagnosed using spectral domain optical coherence tomography (SD-OCT). The diameters of the lamellar defects were measured. Pars plana vitrectomy with epiretinal membrane (ERM) removal and internal limiting membrane (ILM) peeling without endotamponade followed. Follow-up examinations were conducted with SD-OCT for a period of 12 months after surgery. The following factors were examined: maximum and minimum diameter of the lamellar defect, maximum diameter of the disruption of the photoreceptors, representing the photoreceptor layer, central macular thickness, paracentral macular thickness 1000 microm from the centre of the fovea, and maximum paracentral retinal thickness. Retina thickness was measured manually from the inner retina surface to the upper line of retinal pigment epithelium. Prior to surgery, mean visual acuity was 0.2. Twelve months after surgery, the mean visual acuity was 0.51. Lower visual acuity was observed in patients with photoreceptor layer defects localized under the fovea. Epiretinal membranes and complete or partial posterior hyaloid detachment were observed in all cases. The size of the lamellar defect had no influence on final visual acuity. The results obtained show that intraocular gas tamponade is not a crucial step in achieving closure and visual improvement in lamellar macular holes.

  18. [Sighting dominance in patients with macular disease].

    PubMed

    Akaza, Eriko; Fujita, Kyoko; Shimada, Hiroyuki; Yuzawa, Mitsuko

    2007-04-01

    To study sighting dominance by comparing macular disease patients undergoing surgical treatment with controls. We studied visual acuity and sighting dominance in 92 macular disease patients, 27 of whom were assessed for both outcomes. We also studied visual acuity and sighting dominance in 412 controls. Sighting dominance was evaluated using the hole-in-card test. Among the controls, 70% showed right sighting dominance, and 30%, left sighting dominance. On the other hand, in patients with macular disease, right sighting dominance was demonstrated in 51%, and left in 49%; that is, 24% showed sighting dominance of the affected eye and 76%, of the fellow eye. During follow-up, sighting dominance of three of the 27 macular disease patients shifted from the affected eye to the fellow eye, which showed improvement in visual acuity. This study raises the possibility of sighting dominance shifting in patients with macular disease. There were differences among cases in the timing of the shift in sighting dominance, indicating that visual acuity may not be the only factor influencing sighting dominance. Further study is needed to confirm the factors contributing to sighting dominance.

  19. What types of unintentional injuries kill our children? Do infants die of the same types of injuries? A systematic review

    PubMed Central

    Imamura, Janete Honda; Troster, Eduardo Juan; de Oliveira, Carlos Augusto Cardim

    2012-01-01

    The objective of this study was to review mortality from external causes (accidental injury) in children and adolescents in systematically selected journals. This was a systematic review of the literature on mortality from accidental injury in children and adolescents. We searched the PubMed, Latin-American and Caribbean Health Sciences and Excerpta Medica databases for articles published between July of 2001 and June of 2011. National data from official agencies, retrieved by manual searches, were also reviewed. We reviewed 15 journal articles, the 2011 edition of a National Safety Council publication and 2010 statistical data from the Brazilian National Ministry of Health Mortality Database. Most published data were related to high-income countries. Mortality from accidental injury was highest among children less than 1 year of age. Accidental threats to breathing (non-drowning threats) constituted the leading cause of death among this age group in the published articles. Across the pediatric age group in the surveyed studies, traffic accidents were the leading cause of death, followed by accidental drowning and submersion. Traffic accidents constitute the leading external cause of accidental death among children in the countries under study. However, infants were vulnerable to external causes, particularly to accidental non-drowning threats to breathing, and this age group had the highest mortality rates for external causes. Actions to reduce such events are suggested. Further studies investigating the occurrence of accidental deaths in low-income countries are needed to improve the understanding of these preventable events. PMID:23018311

  20. The Impacts of Air Temperature on Accidental Casualties in Beijing, China

    PubMed Central

    Ma, Pan; Wang, Shigong; Fan, Xingang; Li, Tanshi

    2016-01-01

    Emergency room (ER) visits for accidental casualties, according to the International Classification of Deceases 10th Revision Chapters 19 and 20, include injury, poisoning, and external causes (IPEC). Annual distribution of 187,008 ER visits that took place between 2009 and 2011 in Beijing, China displayed regularity rather than random characteristics. The annual cycle from the Fourier series fitting of the number of ER visits was found to explain 63.2% of its total variance. In this study, the possible effect and regulation of meteorological conditions on these ER visits are investigated through the use of correlation analysis, as well as statistical modeling by using the Distributed Lag Non-linear Model and Generalized Additive Model. Correlation analysis indicated that meteorological variables that positively correlated with temperature have a positive relationship with the number of ER visits, and vice versa. The temperature metrics of maximum, minimum, and mean temperatures were found to have similar overall impacts, including both the direct impact on human mental/physical conditions and indirect impact on human behavior. The lag analysis indicated that the overall impacts of temperatures higher than the 50th percentile on ER visits occur immediately, whereas low temperatures show protective effects in the first few days. Accidental casualties happen more frequently on warm days when the mean temperature is higher than 14 °C than on cold days. Mean temperatures of around 26 °C result in the greatest possibility of ER visits for accidental casualties. In addition, males were found to face a higher risk of accidental casualties than females at high temperatures. Therefore, the IPEC-classified ER visits are not pure accidents; instead, they are associated closely with meteorological conditions, especially temperature. PMID:27827842

  1. Pediatric head injuries from earthquakes.

    PubMed

    Martinez-Lage, Juan F; Almagro, María-José; López-Guerrero, Antonio López; Martínez-Lage Azorín, Carlos

    2012-10-01

    By means of some illustrations, the authors briefly report the effects of some accidental head injuries caused by diverse mechanisms occurring in children. Many of these accidents seem to be preventable, but others are completely unavoidable and escape prevention as the one that is depicted in the cover of this issue.

  2. Macular Hole Formation After Intravitreal Ranibizumab Injection in Wet Age-Related Macular Degeneration

    PubMed Central

    Mukherjee, Chandoshi; Mitra, Arijit; Kumar, N. Ajith; Elsherbiny, Samer; Lip, Peck Lin

    2015-01-01

    Ranibizumab is a monoclonal antibody fragment that inhibits angiogenesis by inhibiting vascular endothelial growth factor A, used as a treatment for patients with wet aged-related macular degeneration (ARMD). Adverse effects from intravitreal Ranibizumab injections are well recognised. Macular hole formation following Ranibizumab injection is a complication that has been recently reported in few case reports. We present a larger case series of five patients, who developed full thickness macular holes (FTMH) after intravitreal Ranibizumab injections for treatment of wet ARMD that we were aware of between 2009 and 2013. PMID:26962382

  3. [The age-related macular degeneration as a vascular disease/part of systemic vasculopathy: contributions to its pathogenesis].

    PubMed

    Fischer, Tamás

    2015-03-01

    The wall of blood vessels including those in choroids may be harmed by several repeated and/or prolonged mechanical, physical, chemical, microbiological, immunologic, and genetic impacts (risk factors), which may trigger a protracted response, the so-called host defense response. As a consequence, pathological changes resulting in vascular injury (e. g. atherosclerosis, age-related macular degeneration) may be evolved. Risk factors can also act directly on the endothelium through an increased production of reactive oxygen species promoting an endothelial activation, which leads to endothelial dysfunction, the onset of vascular disease. Thus, endothelial dysfunction is a link between the harmful stimulus and vascular injury; any kind of harmful stimuli may trigger the defensive chain that results in inflammation that may lead to vascular injury. It has been shown that even early age-related macular degeneration is associated with the presence of diffuse arterial disease and patients with early age-related macular degeneration demonstrate signs of systemic and retinal vascular alterations. Chronic inflammation, a feature of AMD, is tightly linked to diseases associated with ED: AMD is accompanied by a general inflammatory response, in the form of complement system activation, similar to that observed in degenerative vascular diseases such as atherosclerosis. All these facts indicate that age-related macular degeneration may be a vascular disease (or part of a systemic vasculopathy). This recognition could have therapeutic implications because restoration of endothelial dysfunction may prevent the development or improve vascular disease resulting in prevention or improvement of age-related macular degeneration as well.

  4. Treatment for Macular Telangiectasia Type 2.

    PubMed

    Charbel Issa, Peter; Kupitz, Elke H; Heeren, Tjebo F C; Holz, Frank G

    2016-01-01

    Macular telangiectasia (MacTel) type 2 is a bilateral disease of unknown cause with localized retinal degeneration and characteristic changes of the retinal vasculature. Funduscopic findings include reduced retinal transparency, crystalline deposits, ectatic capillaries, blunted venules, retinal pigment plaques, foveal atrophy and neovascular complexes. Leakage of telangiectatic macular capillaries is a characteristic finding on fluorescein angiography, and neurosensory atrophy may be present on optical coherence tomography images. Furthermore, there is a specific depletion of macular pigment in the central retina. Depending on the development of neovascular membranes, a nonproliferative and a proliferative (neovascular) disease stage may be distinguished. To date, there is no evidence for an effective treatment of nonproliferative MacTel type 2. Patients with proliferative MacTel type 2 and hence decreasing visual function may benefit from intravitreal application of vascular endothelial growth factor inhibitors. Early treatment and a small size of the neovascular membrane might be predictive factors for visual function outcome.

  5. [Epidemiology and development of macular edema in the diabetic].

    PubMed

    Zghal-Mokni, I; Jeddi, A; Boujemaa, C; Ben Hadj Alouane, W; Gaigi, S; Ayed, S

    2001-12-01

    Macular edema is the first cause of blindness in diabetics. Macular edema is defined by macular thickening or deposits of hard exudates. On 1000 diabetics examined over 2 years, 60 patients had a macular edema of which we retained 38 cases(54 eyes). All the patients had an ophthalmologic examination with a retinal angiography. Laser photocoagulation with green Argon laser was instituted in 50 eyes. 63% had background rethinopathy. Total or partial regression of the edema happened in 84.4%. Laser photocoagulation decrease by the half vision loss risk. Interest of early detection and treatment to decrease blindness incidence of macular edema in diabetics.

  6. Macular holes: vitreoretinal relationships and surgical approaches.

    PubMed

    Bainbridge, J; Herbert, E; Gregor, Z

    2008-10-01

    Idiopathic full-thickness macular holes develop as a result of anteroposterior and tangential traction exerted by the posterior vitreous cortex at the fovea. Vitreoretinal relationships during the development of macular holes can be demonstrated in detail by ocular coherence tomography, facilitating an improved understanding of their pathogenesis and guiding clinical management. Surgical strategies for the repair of macular holes are designed to relieve vitreofoveal traction and to promote flattening and reapposition of the macular hole edges by intraocular gas tamponade. A period of face-down positioning postoperatively is conventionally advised. However, the evidence to support this recommendation is weak and practice varies considerably. Surgical removal of the inner limiting membrane (ILM) is advocated to ensure thorough removal of any tangential tractional components including any residual cortical vitreous. Current evidence suggests that ILM peeling can improve anatomical outcomes but the effect on visual function is less predictable; unsuccessful attempts to peel the ILM can be associated with poor visual outcome. The use of vital dyes can facilitate visualisation of the ILM and help achieve complete, atraumatic peeling. Indocyanine green dye can enable high rates of macular hole closure but has been associated with poorer visual outcomes suggesting a dose-dependent toxicity. Trypan blue dye offers an alternative that may have a more favourable risk profile. An improved understanding of vitreoretinal relationships may facilitate a tailored approach to surgery in individuals with macular holes. Vitrectomy to relieve anteroposterior traction is central in the management of all full-thickness holes. The use of long-acting gases, prolonged face-down positioning, and ILM peeling may be more valuable for larger holes, longstanding holes, and those that have failed to close following conventional surgery.

  7. [New aspects in age related macular degeneration].

    PubMed

    Turlea, C

    2012-01-01

    Being the leading cause of blindness in modern world Age Related Macular Degeneration has beneficiated in the last decade of important progress in diagnosis, classification and the discovery of diverse factors who contribute to the etiology of this disease. Treatments have arised who can postpone the irreversible evolution of the disease and thus preserve vision. Recent findings have identified predisposing genetic factors and also inflamatory and imunological parameters that can be modified trough a good and adequate prevention and therapy This articole reviews new aspects of patology of Age Related Macular Degeneration like the role of complement in maintaining inflamation and the role of oxidative stress on different structures of the retina.

  8. Simulating vision with and without macular disease.

    PubMed

    Marmor, David J; Marmor, Michael F

    2010-01-01

    Conventional photographs do not show how, at any moment of visual fixation, neural vision is clear only in the foveal center. We have developed new computer simulations to show both normal vision and vision with macular disease. These simulations show the nature of momentary vision for life tasks such as reading, facial recognition, and walking in the street. They also dramatically show the impact of macular disease (with scotomas and visual distortion), as there is no surrounding region of clarity. We hope these images will be instructive to both physicians and patients.

  9. Effect of macular edema on optical coherence tomography signal strength.

    PubMed

    Hosseini, Hamid; Razeghinejad, Mohammad Reza; Nowroozizadeh, Sarah; Jafari, Peyman; Ashraf, Hossein

    2010-01-01

    The purpose of this study was to examine the effect of macular edema (ME) on Stratus optical coherence tomography (OCT) (Stratus OCT, Carl Zeiss Meditec, Dublin, CA) signal strength (SS). Part 1: Macular OCT was performed in 57 eyes with ME, at 2 different time points with different degrees of ME. The relationships between SS change and change in center point thickness and total macular volume in two scans were examined. Part 2: In 54 eyes with ME, Stratus OCT examinations with macular thickness mapping and retinal nerve fiber layer analysis protocols were performed. The paired values of SS obtained with two scan protocols were compared. The relationship between SS difference between two test protocols with center point thickness and total macular volume was evaluated. Part 1: There was a significant correlation between SS change and the change in center point thickness and total macular volume in 2 consecutive scans. Part 2: Maximum SS obtained during macular OCT examination was significantly less than that obtained during retinal nerve fiber layer OCT. Significant correlations were observed between the difference in SS obtained in two scan protocols and center point thickness as well as total macular volume. Macular edema decreases macular OCT SS. In patients with ME, SS obtained during macular OCT examination was significantly lower than that obtained during retinal nerve fiber layer OCT examination.

  10. Angiographically Documented Macular Ischemia after Single Bevacizumab for Macular Edema Secondary to Central Retinal Vein Occlusion.

    PubMed

    Lee, Kyou Ho; Kang, Eui Chun; Koh, Hyoung Jun

    2017-05-01

    This report describes a case of angiographically documented foveal avascular zone (FAZ) enlargement after a single intravitreal injection of bevacizumab for macular edema secondary to central retinal vein occlusion (CRVO). A 71-year-old female was treated with an intravitreal bevacizumab injection for macular edema following CRVO. Despite successfully decreased edema one month after injection, the postinjection best-corrected visual acuity immediately decreased from 20/40 to 20/1000 (Snellen equivalent). The FAZ area increased from 0.37 mm² to 3.11 mm² (8.4-fold increase). While intravitreal anti-vascular endothelial growth factor is effective and should be considered as a first-line treatment for macular edema secondary to CRVO, it may aggravate macular ischemia. © Copyright: Yonsei University College of Medicine 2017.

  11. Age-related macular degeneration.

    PubMed

    Cheung, Lily K; Eaton, Angie

    2013-08-01

    Age-related macular degeneration (AMD) is the leading cause of blindness in the elderly, and the prevalence of the disease increases exponentially with every decade after age 50 years. It is a multifactorial disease involving a complex interplay of genetic, environmental, metabolic, and functional factors. Besides smoking, hypertension, obesity, and certain dietary habits, a growing body of evidence indicates that inflammation and the immune system may play a key role in the development of the disease. AMD may progress from the early form to the intermediate form and then to the advanced form, where two subtypes exist: the nonneovascular (dry) type and the neovascular (wet) type. The results from the Age-Related Eye Disease Study have shown that for the nonneovascular type of AMD, supplementation with high-dose antioxidants (vitamin C, vitamin E, and β-carotene) and zinc is recommended for those with the intermediate form of AMD in one or both eyes or with advanced AMD or vision loss due to AMD in one eye. As for the neovascular type of the advanced AMD, the current standard of therapy is intravitreal injections of vascular endothelial growth factor inhibitors. In addition, lifestyle and dietary modifications including improved physical activity, reduced daily sodium intake, and reduced intake of solid fats, added sugars, cholesterol, and refined grain foods are recommended. To date, no study has demonstrated that AMD can be cured or effectively prevented. Clearly, more research is needed to fully understand the pathophysiology as well as to develop prevention and treatment strategies for this devastating disease.

  12. Accidental carotid artery catheterization during attempted central venous catheter placement: a case report.

    PubMed

    Maietta, Pauline Marie

    2012-08-01

    More than 2.1 million central venous catheters are placed annually. While carotid artery cannulation is rare, its effects can be devastating. Anesthesia providers frequently work with central venous catheters in the perioperative setting. Therefore, it is imperative that they be able to identify and react appropriately to carotid artery injury both in preexisting central lines and those that they have placed. This case report details a case of accidental carotid artery catheterization during attempted right internal jugular vein catheterization and the steps taken to treat the patient following its recognition. A discussion of technique for central venous catheterization, indications for suspicion of arterial puncture, methods for confirming venous or arterial placement, appropriate methods for management of carotid artery cannulation, and the benefit of ultrasound in central venous cannulation follow. Through the appropriate use of equipment, early detection and management of carotid artery injury, and proper training, patient outcomes may be improved.

  13. Quick management of accidental tritium exposure cases.

    PubMed

    Singh, Vishwanath P; Badiger, N M; Managanvi, S S; Bhat, H R

    2012-07-01

    Removal half-life (RHL) of tritium is one of the best means for optimising medical treatment, reduction of committed effective dose (CED) and quick/easy handling of a large group of workers for medical treatment reference. The removal of tritium from the body depends on age, temperature, relative humidity and daily rainfall; so tritium removal rate, its follow-up and proper data analysis and recording are the best techniques for management of accidental acute tritium exposed cases. The decision of referring for medical treatment or medical intervention (MI) would be based on workers' tritium RHL history taken from their bodies at the facilities. The workers with tritium intake up to 1 ALI shall not be considered for medical treatment as it is a derived limit of annual total effective dose. The short-term MI may be considered for tritium intake of 1-10 ALI; however, if the results show intake ≥100 ALI, extended strong medical/therapeutic intervention may be recommended based on the severity of exposure for maximum CED reduction requirements and annual total effective dose limit. The methodology is very useful for pressurized heavy water reactors (PHWRs) which are mainly operated by Canada and India and future fusion reactor technologies. Proper management will optimise the cases for medical treatment and enhance public acceptance of nuclear fission and fusion reactor technologies.

  14. Accidental death via intravaginal absorption of methamphetamine.

    PubMed

    Jones, Prentiss; Mutsvunguma, Romeo; Prahlow, Joseph A

    2014-06-01

    In this paper a drug fatality that involved an unintended drug delivery route is described. The decedent, a 23-year-old female in custody in a county jail on suspicion of a felony drug offense, was discovered in a holding cell unconscious and unresponsive. Following unsuccessful cardiopulmonary resuscitation attempts she was pronounced dead at the scene. At autopsy a wad of multiple small loosely wrapped plastic packages held together with another layer of clear plastic was found in the decedent's vagina. The smaller plastic packages contained an off-white pasty substance that was later identified as methamphetamine. Toxicological testing of specimens collected during autopsy revealed methamphetamine in the decedent's subclavian blood, vitreous fluid, and urine at extremely high concentrations (42.6, 20.1, and 771 mg/L, respectively). Amphetamine, the active metabolite of methamphetamine, was also present in the subclavian blood, vitreous fluid, and urine at significant concentrations (1.3, 0.5, and 20.4 mg/L, respectively). The cause of death was attributed to toxic effects of methamphetamine and the manner of death was ruled accidental. This report suggests that lethal concentrations of methamphetamine may be distributed to the systemic circulation via intravaginal absorption.

  15. Surgical outcomes of macular buckling techniques for macular retinoschisis in highly myopic eyes

    PubMed Central

    Mateo, Carlos; Gómez-Resa, María V.; Burés-Jelstrup, Anniken; Alkabes, Micol

    2013-01-01

    Purpose To report the anatomic and visual results following macular buckling for patients with macular retinoschisis related to high myopia. Methods Thirty-nine highly myopic eyes (mean refractive error −16.7 D; range, −9 to −24 D) of 36 patients (mean age 59 years; range, 35–79 years) presenting with macular retinoschisis associated with a posterior staphyloma, who underwent combined vitrectomy and macular buckling were evaluated. Main outcome measures included best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) findings. Three cases were excluded due to short follow-up (less than 3 months). The mean follow-up was 16 months. Results The mean BCVA increased from 0.76 to 0.43 LogMAR (p = 0.001). Visual acuity improved in 30 eyes (83.3%), remained stable in three eyes (8.3%) and decreased in three eyes (8.3%). OCT showed resolution of foveoschisis with foveal reattachment in all eyes. None of the evaluated patients developed a macular hole during follow-up. Conclusion Macular buckling associated with vitrectomy results in good anatomic and visual outcomes in patients with myopic foveoschisis. PMID:24409086

  16. Assessment of Macular Function during Vitrectomy: New Approach Using Intraoperative Focal Macular Electroretinograms

    PubMed Central

    Matsumoto, Celso Soiti; Shinoda, Kei; Terauchi, Gaku; Matsumoto, Harue; Mizota, Atsushi; Miyake, Yozo

    2015-01-01

    Purpose To describe a new technique to record focal macular electroretinograms (FMERGs) during vitrectomy to assess macular function. Methods Intraoperative FMERGs (iFMERGs) were recorded in ten patients (10 eyes) who undergo vitrectomy. iFMERGs were elicited by focal macular stimulation. The stimulus light was directed to the macular area through a 25 gauge (25G) glass fiber optic bundle. Background light was delivered through a dual chandelier-type light fiber probe. Focal macular responses elicited with combinations of stimulus and background luminances were analyzed. Results A stimulus luminance that was approximately 1.75 log units brighter than the background light was able to elicit focal macular responses that were not contaminated by stray light responses. Thus, a stimulus luminance of 160 cd/m2 delivered on a background of 3 cd/m2 elicited iFMEGs from only the stimulated area. This combination of stimulus and background luminances did not elicit a response when the stimulus was projected onto the optic nerve head. The iFMERGs elicited by a 10° stimulus with a duration of 100 ms and an interstimulus interval of 150 ms consisted of an a-, b-, and d-waves, the oscillatory potentials, and the photopic negative response (PhNR). Conclusions Focal ERGs with all components can be recorded from the macula and other retinal areas during vitreous surgery. This new technique will allow surgeons to assess the function of focal areas of the retina intraoperatively. PMID:26658489

  17. Progression of Macular Atrophy in Pattern Dystrophies.

    PubMed

    Pallado, Céline Mebsout; Sikorav, Anne; Semoun, Oudy; Jung, Camille; Souied, Eric H

    2016-07-01

    To quantify the progression of macular atrophy associated with pattern dystrophies (PD). Retrospective, observational study including patients with reticular PD and macular atrophy. A detailed ophthalmologic exam was performed, and progression of macular atrophy areas was evaluated on fundus autofluorescence frames using RegionFinder software, a semiautomated software embedded in Spectralis device (Heidelberg Engineering, Heidelberg, Germany). We included 19 eyes of 12 patients. The median follow-up was 4.5 years (interquartile range [IQR]: 2.7-5.5). Three eyes (16%) had choroidal neovascularization. Atrophy involved foveal area in 21% (four of 19) of cases. Decreased vision occurred in three eyes (16%). The median atrophy progression rate evaluated by RegionFinder software was 0.101 mm(2)/year (IQR: 0.054-0.257). The progression of macular atrophy in PDs appears to be relatively slow. Further studies are necessary to correlate the progression of atrophy in PDs with genetic data. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:652-658.]. Copyright 2016, SLACK Incorporated.

  18. Depression in Age-Related Macular Degeneration

    ERIC Educational Resources Information Center

    Casten, Robin; Rovner, Barry

    2008-01-01

    Age-related macular degeneration (AMD) is a major cause of disability in the elderly, substantially degrades the quality of their lives, and is a risk factor for depression. Rates of depression in AMD are substantially greater than those found in the general population of older people, and are on par with those of other chronic and disabling…

  19. Driving and Age-Related Macular Degeneration

    ERIC Educational Resources Information Center

    Owsley, Cynthia; McGwin, Gerald, Jr.

    2008-01-01

    This article reviews the research literature on driving and age-related macular degeneration, which is motivated by the link between driving and the quality of life of older adults and their increased collision rate. It addresses the risk of crashes, driving performance, driving difficulty, self-regulation, and interventions to enhance, safety,…

  20. Depression in Age-Related Macular Degeneration

    ERIC Educational Resources Information Center

    Casten, Robin; Rovner, Barry

    2008-01-01

    Age-related macular degeneration (AMD) is a major cause of disability in the elderly, substantially degrades the quality of their lives, and is a risk factor for depression. Rates of depression in AMD are substantially greater than those found in the general population of older people, and are on par with those of other chronic and disabling…

  1. Driving and Age-Related Macular Degeneration

    ERIC Educational Resources Information Center

    Owsley, Cynthia; McGwin, Gerald, Jr.

    2008-01-01

    This article reviews the research literature on driving and age-related macular degeneration, which is motivated by the link between driving and the quality of life of older adults and their increased collision rate. It addresses the risk of crashes, driving performance, driving difficulty, self-regulation, and interventions to enhance, safety,…

  2. [Macular imaging with optical coherence tomography].

    PubMed

    Pal, E; Givort, G; Laroche, A; Barale, P O; Limon, S; Ullern, M

    1998-01-01

    Optical Coherence Tomography (OCT) is a novel noninvasive and noncontact imaging technique providing cross-sectional representations of the eye structures. OCT is analogous to Ultrasound B-scan, except that it analyzes the reflection of a 850 nm light wave. The aim of this study was to assess the potential of ocular coherence tomography for diagnosing and monitoring macular diseases. Cross-sectional images were performed with the Zeiss-Humphrey OCT. Over one year period, we examined approximately 300 patients with idiopathic full thickness macular hole, lamellar hole, cystoid macular edema, choroidal new vessels, epiretinal membrane, diabetic maculopathy, and central serous chorioretinopathy. OCT can provide new information concerning the posterior pole diseases mentioned above. OCT can also be useful in thickness measurements. OCT allows tomographic analysis of macular diseases. The information obtained is different from that obtained by histologic study which is sometimes hard to interprete. OCT is mostly useful in studying internal layers of the retina. Further applications may be developed.

  3. Macular Amyloidosis and Epstein-Barr Virus

    PubMed Central

    Nahidi, Yalda; Tayyebi Meibodi, Naser; Meshkat, Zahra; Nazeri, Narges

    2016-01-01

    Background. Amyloidosis is extracellular precipitation of eosinophilic hyaline material of self-origin with special staining features and fibrillar ultrastructure. Macular amyloidosis is limited to the skin, and several factors have been proposed for its pathogenesis. Detection of Epstein-Barr virus (EBV) DNA in this lesion suggests that this virus can play a role in pathogenesis of this disease. Objective. EBV DNA detection was done on 30 skin samples with a diagnosis of macular amyloidosis and 31 healthy skin samples in the margin of removed melanocytic nevi by using PCR. Results. In patients positive for beta-globin gene in PCR, BLLF1 gene of EBV virus was positive in 23 patients (8 patients in case and 15 patients in the control group). There was no significant difference in presence of EBV DNA between macular amyloidosis (3.8%) and control (23.8%) groups (P = 0.08). Conclusion. The findings of this study showed that EBV is not involved in pathogenesis of macular amyloidosis. PMID:26981113

  4. Macular colobomas in Leber's congenital amaurosis.

    PubMed

    Margolis, S; Scher, B M; Carr, R E

    1977-01-01

    Two siblings with Leber's congenital amaurosis had the unusual association of bilateral macular colobomas. In addition to the colobomas, the patients also had deafmutism, severe myopia, large corneas, and an unusual discrete area of peripapillary tapetoretinal sheen. Electrodiagnostic evaluation of patients with congenitally poor visual ascuity and a central retinal defect differentiated a localized loss of funciton from a degeneration involving the entire retina.

  5. Bilateral macular colobomas in Leber's congenital amaurosis.

    PubMed

    Murayama, K; Adachi-Usami, E

    1989-06-01

    Two siblings with Leber's congenital amaurosis had bilateral macular colobomas, nystagmus, extinguished ERGs, and degenerative salt and pepper like changes in the fundus. They had non-recordable or non-meaningful visually evoked cortical potentials in response to both flash and pattern stimuli. The ophthalmic conditions were thought to be inherited as an autosomal recessive trait.

  6. [Infrared imaging of outer lamellar macular holes].

    PubMed

    Schaal, K B; Jakob, E; Dithmar, S

    2011-01-01

    Outer lamellar macular holes (OLMH) are very rare compared to inner lamellar macular holes. An OLMH can occur associated with optic pit maculopathy, in the progression of myopic macular retinoschisis, transient in the development of full thickness macular holes or idiopathic. This article reports on infrared imaging of OLMHs. Infrared (IR) images in 2 patients aged 22 and 34 years with OLMH were taken using IR reflection at a wavelength of 820 nm with a confocal scanning laser ophthalmoscope (Heidelberg Retina Angiograph 2, Heidelberg Engineering). IR images were correlated with linear optical coherence tomography (OCT) scans (Stratus-OCT, Zeiss). Images were acquired during follow-up of up to 30 months and if applicable preoperatively and postoperatively. Clear infrared signals were recorded especially in OLMH associated with optic pit maculopathy. Correlation with linear OCT scans showed the enhanced infrared signals to be restricted to the extent of the OLMH. The borders of the OLMH could be clearly delineated. Infrared imaging enables a top view of OLMH and therefore allows an excellent documentation of the course of OLMH. Infrared reflection is useful for two-dimensional imaging of OLMH. Infrared imaging can provide a supplement to slice imaging for OCT diagnostics and allows monitoring of OLMH over time. The postoperative sequence of OLMH closure in patients with optic pit maculopathy can be studied in more detail using infrared imaging.

  7. INTRAVITREAL CORTICOSTEROIDS IN DIABETIC MACULAR EDEMA

    PubMed Central

    Bailey, Clare; Loewenstein, Anat; Massin, Pascale

    2015-01-01

    Purpose: To review the relationship between kinetics, efficacy, and safety of several corticosteroid formulations for the treatment of diabetic macular edema. Methods: Reports of corticosteroid use for the treatment of diabetic macular edema were identified by a literature search, which focused on the pharmacokinetics, efficacy, and safety of these agents in preclinical animal models and clinical trials. Results: Available corticosteroids for diabetic macular edema treatment include intravitreal triamcinolone acetonide, dexamethasone, and fluocinolone acetonide. Because of differences in solubility and bioavailability, various delivery mechanisms are used. Bioerodible delivery systems achieve higher maximum concentrations than nonbioerodible formulations. There is a relationship between visual gains and drug persistence in the intravitreal compartment. Safety effects were more complex; level of intravitreal triamcinolone acetonide exposure is related to development of elevated intraocular pressure and cataract; this does not seem to be the case for dexamethasone, where two different doses showed similar mean intraocular pressure and incidence of cataract surgery. With fluocinolone acetonide, rates of intraocular pressure elevations requiring surgery seem to be dose related; rates of cataract extraction were similar regardless of dose. Conclusion: Available corticosteroids for diabetic macular edema exhibit different pharmacokinetic profiles that impact efficacy and adverse events and should be taken into account when developing individualized treatment plans. PMID:26352555

  8. The Intravitreal Autologous Platelet Concentrate Injection as an Adjunct of Vitrectomy for the Treatment of Refractory Macular Holes

    ClinicalTrials.gov

    2014-03-06

    Macular Hole With High Myopia (Spherical Equivalent ≤ -6.0 Diopters) or,; Large Size Macular Hole (Diameter > 600 Microns) or; Recurred or Failed Macular Hole From Previous Surgery; or Chronic Macular Hole (Symptom Duration > 6 Months)

  9. Accidental Implant Screwdriver Ingestion: A Rare Complication during Implant Placement

    PubMed Central

    Jain, Anshul; Baliga, Shridhar D

    2014-01-01

    One of the complications during a routine dental implant placement is accidental ingestion of the implant instruments, which can happen when proper precautions are not taken. Appropriate radiographs should be taken to locate the correct position of foreign body; usually the foreign body passes asymptomatically from gastrointestinal tract but sometimes it may lead to intestinal obstruction, perforations and impactions. The aim of this article is to report accidental ingestion of 19 mm long screw driver by a senile patient. PMID:25628702

  10. Risk factors for unnatural death: Fatal accidental intoxication, undetermined intent and suicide: Register follow-up in a criminal justice population with substance use problems.

    PubMed

    Olsson, Martin O; Bradvik, Louise; Öjehagen, Agneta; Hakansson, Anders

    2016-05-01

    Risk factors for suicide and fatal accidental intoxication are extensively studied, while risk factors for intoxications/injuries of undetermined intent are less well known. The latter have shown an overlap with suicides, but also with fatal accidental intoxications. The objective was to analyze potential differences and similarities in the patterns of risk factors for accidental intoxications, injuries/intoxications with undetermined intent, and suicides, respectively. A follow-up register study was conducted, using data from ASI interviews with clients in the criminal justice system in Sweden (n=6744), followed in the National Causes of Death Register. A set of risk factors from the ASI interview were tested in bivariate analysis with the respective cause of death, yielding significant risk factors further analyzed in three Cox regression models. In Cox regression analyses, death from fatal accidental intoxication was associated with male gender (HR 4.09), use of heroin (HR 2.86), and use of cannabis (HR 1.94), and death from intoxication/injury of undetermined intent was associated with use of heroin (HR 3.48), binge drinking of alcohol (HR 2.46) and previous psychiatric hospitalization (HR 2.41), while negatively associated with depression (HR 0.33). Death from suicide was associated with previous suicide attempts (HR 2.78) and use of sedatives (HR 2.17). In this population of criminal justice clients with reported substance use problems, fatal injuries/intoxications with undetermined intent - like fatal accidental intoxications - appear to be associated with substance use variables, and cannot readily be assumed to represent the same background factors as suicide. Copyright © 2016. Published by Elsevier Ireland Ltd.

  11. Accidental death resulting from acetylene cylinder impact.

    PubMed

    Rani, Mukta; Gupta, Avneesh; Dikshit, P C; Aggrawal, Anil; Setia, Puneet; Dhankar, Vijay

    2005-06-01

    Acetylene is an inflammable gas commonly used for welding in small-scale industries. We present a case of a 34-year-old male welder who died following injuries sustained from explosion of an acetylene gas-welding cylinder. In this case report, we discuss the circumstances leading to the explosion of the welding cylinder, the autopsy findings, and a brief review of the literature on deaths resulting from blasts of acetylene cylinders.

  12. Freon: accidental ingestion and gastric perforation.

    PubMed

    Gotelli, Mariano Javier; Monserrat, Alberto Juan; Lo Balbo, Alfredo; Valdes Quintana, Eduardo Fernando; Gotelli, Carlos

    2008-04-01

    Freons generally have a low order of toxicity, but exposure to relatively high concentrations (>100 ppm) may produce adverse effects on health. Currently, intoxication reports are unintentional inhalation of CFCs. We report an unintentional ingestion of a mixture of CFCs and the results of a rat study. A 43-year-old man was admitted to the Emergency Department with a chief complaint of acute abdominal pain that developed minutes after he ingested a clear liquid in a water glass, which contained a mixture of Freon and water. Subsequent surgical evaluation revealed perforation of the stomach and necrosis of the stomach wall. He developed a transient rise in his hepatic transaminases, which resolved spontaneously, and fully recovered from his surgery. A murine model of the injury was created to evaluate threshold concentration and effect of time on injury grade. Injury grade increased with delay to histologic analysis from 8 to 24 hours after exposure to Freon. Increasing amounts of Freon also increased the lesion grade score. Patients ingesting Freon need to be closely evaluated for risk of gastric damage and perforation.

  13. “Magic Bullet”: Eccentric Macular Hole as a Complication from Dexamethasone Implant Insertion

    PubMed Central

    Sanders, Riley; Olson, Jeffrey

    2016-01-01

    Introduction. Intravitreal drug injections and implants are generally safe but do carry some risk, from both the procedure itself and adverse effects of the medications. We report a case of an eccentric macular hole after dexamethasone implant (Ozurdex®) administration. Ex vitro force testing was performed to evaluate dexamethasone implant injection force. Methods. Five dexamethasone implant (Ozurdex) applicators were placed 16 mm from a force plate and the force of the injected dexamethasone pellet was recorded in Newtons. Four dexamethasone implant applicators were placed 16 mm from a force plate in a basic saline solution and the force of the pellet was recorded. Results. Average maximum force in air was 0.77 N and 0.024 N in a basic saline solution (BSS). Conclusion. We present a case report of an eccentric macular hole after dexamethasone implant administration. We hypothesize a mechanical injury to the retina during insertion caused the macular hole. Force testing done in air demonstrated sufficient force from the pellet injection to cause retinal damage though injections done in BSS showed reduced forces. PMID:27800199

  14. Image-guided macular laser therapy: design considerations and progress toward implementation

    NASA Astrophysics Data System (ADS)

    Berger, Jeffrey W.; Shin, David S.

    1999-06-01

    Laser therapy is currently the only treatment of proven benefit for exudative age related macular degeneration and diabetic retinopathy. To guide treatment for macular diseases, investigations were initiated to permit overlay of previously-stored angiographic images and image sequences superimposed onto the real-time biomicroscopic fundus image. Prior to treatment, a set of partially overlapping fundus images is acquired and montaged in order to provide a map for subsequent tracking operations. A binocular slit-lamp biomicroscope interfaced to a CCD camera, framegrabber board, and PC permits acquisition and rendering of retinal images. Computer-vision algorithms facilitate robust tracking, registration, and near-video-rate image overlay of previously-stored retinal photographic and angiographic images onto the real-time fundus image. Laser treatment is guided in this augmented reality environment where the borders of the treatment target--for example, the boundaries of a choroidal neovascularization complex--are easily identified through overlay of angiographic information superimposed on, and registered with, the real-time fundus image. During periods of misregistration as judged by the amplitude of the tracking similarity metric, laser function is disabled, affording additional safety. Image-guided macular laser therapy should facilitate accurate targeting of treatable lesions and less unintentional retinal injury when compared with standard techniques.

  15. Parental Perceptions of Hospital Care in Children with Accidental or Alleged Non-Accidental Trauma

    ERIC Educational Resources Information Center

    Ince, Elif E.; Rubin, David; Christian, Cindy W.

    2010-01-01

    Objective: To determine whether a suspicion or diagnosis of child abuse during hospitalization influences parental perceptions of hospital care in families of children admitted with traumatic injuries. Method: Parents of children younger than 6 years of age admitted with traumatic injuries to a large urban children's hospital were recruited to…

  16. Parental Perceptions of Hospital Care in Children with Accidental or Alleged Non-Accidental Trauma

    ERIC Educational Resources Information Center

    Ince, Elif E.; Rubin, David; Christian, Cindy W.

    2010-01-01

    Objective: To determine whether a suspicion or diagnosis of child abuse during hospitalization influences parental perceptions of hospital care in families of children admitted with traumatic injuries. Method: Parents of children younger than 6 years of age admitted with traumatic injuries to a large urban children's hospital were recruited to…

  17. Effect of change in macular birefringence imaging protocol on retinal nerve fiber layer thickness parameters using GDx VCC in eyes with macular lesions.

    PubMed

    Dada, Tanuj; Tinwala, Sana I; Dave, Vivek; Agarwal, Anand; Sharma, Reetika; Wadhwani, Meenakshi

    2014-08-01

    This study evaluates the effect of two macular birefringence protocols (bow-tie retardation and irregular macular scan) using GDx VCC on the retinal nerve fiber layer (RNFL) thickness parameters in normal eyes and eyes with macular lesions. In eyes with macular lesions, the standard protocol led to significant overestimation of RNFL thickness which was normalized using the irregular macular pattern protocol. In eyes with normal macula, absolute RNFL thickness values were higher in irregular macular pattern protocols with the difference being statistically significant for all parameters except for inferior average thickness. This has implications for monitoring glaucoma patients who develop macular lesions during the course of their follow-up.

  18. Do accidents happen accidentally? A study of trauma registry and periodical examination database.

    PubMed

    Avi, A; Yehonatan, S; Alon, S; Alexandra, H; Arieh, E

    2001-01-01

    Health profile of trauma victims might affect accident involvement. Information linking medical data to accident epidemiology is lacking. This study aims to identify health factors that increase risk of accident involvement. The Israeli Defense Forces maintains two databases: records of periodical health examination of military personnel and a trauma registry including emergency department referrals of personnel resulting from injury. We identified 5,578 subjects who were examined in the Periodical Health Examination Center and were victims of trauma. We analyzed relation between injuries and various health parameters. Results shows cigarette smoking is more frequent among the population involved in trauma (40% in motor vehicle crash, 37% in fall injury, and 31% in blunt contusion compared with 28% in Periodical Health Examination Center population not involved in trauma, p < 0.05). Odds ratio of smokers involvement in motor vehicle crash is 1.82 (95% confidence interval, 1.25-2.67, p < 0.005). Younger age is relatively more frequent among trauma victims. We conclude that cigarette smokers and younger subjects might be at greater risk of being involved in accidental injuries.

  19. Spontaneous disappearance of traumatic macular holes in young patients.

    PubMed

    Kusaka, S; Fujikado, T; Ikeda, T; Tano, Y

    1997-06-01

    To report the disappearance of traumatic macular hole in three eyes of three patients. Clinical data of the patients were reviewed. The three patients were relatively young, ranging in age from 12 to 18 years old. In one eye of each patient, a small traumatic macular hole was observed at the first visit. Visual acuities ranged from 20/100 to 20/40. The macular holes resolved spontaneously 3 to 4 months after the trauma, and final visual acuity improved to 20/20 in all patients. Small traumatic macular holes in young patients can resolve spontaneously, and this can be associated with good visual recovery.

  20. Leber Hereditary Optic Neuropathy Associated with Bilateral Macular Holes

    PubMed Central

    2016-01-01

    ABSTRACT Leber hereditary optic neuropathy (LHON) causes visual loss, predominantly in healthy young men. We recently examined a patient who previously had bilateral macular holes and subsequently developed LHON at 74 years of age. Although his central scotomas were initially attributed to the macular holes, his visual acuity declined following an initial improvement after operative closure of the macular holes; thus, other diagnoses, including LHON, were considered. Furthermore, macular optical coherence tomography (OCT) images remained unchanged in this time. A mitochondrial genetic analysis identified a 11778G→A mutation. From this case, we propose that LHON remains in the differential diagnosis even in older patients, as has previously been reported. PMID:27335507

  1. Leber Hereditary Optic Neuropathy Associated with Bilateral Macular Holes.

    PubMed

    Shimada, Yoshiaki; Horiguchi, Masayuki

    2016-05-03

    Leber hereditary optic neuropathy (LHON) causes visual loss, predominantly in healthy young men. We recently examined a patient who previously had bilateral macular holes and subsequently developed LHON at 74 years of age. Although his central scotomas were initially attributed to the macular holes, his visual acuity declined following an initial improvement after operative closure of the macular holes; thus, other diagnoses, including LHON, were considered. Furthermore, macular optical coherence tomography (OCT) images remained unchanged in this time. A mitochondrial genetic analysis identified a 11778G→A mutation. From this case, we propose that LHON remains in the differential diagnosis even in older patients, as has previously been reported.

  2. Accidental foveal photocoagulation secondary to alexandrite laser.

    PubMed

    Anaya-Alaminos, Roberto; Muñoz-Ávila, José I; González-Gallardo, María C; Mora-Horna, Eduardo R; García-Serrano, José L; Ramírez-Garrido, María V

    2014-01-01

    In recent years, we have seen an increase in the use of laser systems in the field of aesthetics (mainly depigmentation and hair removal). Alexandrite laser is the most widely used.Case report. Case report. We describe a case of retinal injury (foveal photocoagulation) directly related to an alexandrite laser hair removal procedure. Hair removal by laser systems is a fast and efficient method. The use of lasers without adequate protective measures or by unqualified personnel increases the risk of ocular adverse effects.

  3. Cost of accidental carbon monoxide poisoning: A preventable expense.

    PubMed

    Hampson, Neil B

    2016-06-01

    Carbon monoxide (CO) poisoning is common in the United States, accounting for hundreds of deaths and thousands of emergency department visits annually. It is believed that most accidental CO poisoning is preventable through public education, warning labels on consumer products, and uniform use of residential CO alarms. However, cost effectiveness of these prevention strategies has not been demonstrated in the United States to date. It was the objective of this study to estimate societal cost of accidental CO poisoning and evaluate the cost-effectiveness of universal installation of residential CO alarms. Published studies and data from the English language literature were used in to estimate direct hospital costs and lost earnings resulting from accidental CO poisoning. The study was performed in the US in 2015. Approximately 6600 individuals are estimated to sustain long-term cognitive sequela annually, with total loss in earnings of approximately $925 million, 334 individuals die from accidental, non-fire related CO poisoning with an average loss of 26 years of productivity accounting for $355 million, and 2800 are hospitalized with acute medical care costs of $33 million. Available data indicate that accidental CO poisoning in the US conservatively costs society over $1.3 billion, resulting from direct hospital costs and lost earnings. Further, it demonstrates a positive cost-benefit ratio for the uniform use of residential CO alarms.

  4. Cost of accidental carbon monoxide poisoning: A preventable expense

    PubMed Central

    Hampson, Neil B.

    2015-01-01

    Carbon monoxide (CO) poisoning is common in the United States, accounting for hundreds of deaths and thousands of emergency department visits annually. It is believed that most accidental CO poisoning is preventable through public education, warning labels on consumer products, and uniform use of residential CO alarms. However, cost effectiveness of these prevention strategies has not been demonstrated in the United States to date. It was the objective of this study to estimate societal cost of accidental CO poisoning and evaluate the cost-effectiveness of universal installation of residential CO alarms. Published studies and data from the English language literature were used in to estimate direct hospital costs and lost earnings resulting from accidental CO poisoning. The study was performed in the US in 2015. Approximately 6600 individuals are estimated to sustain long-term cognitive sequela annually, with total loss in earnings of approximately $925 million, 334 individuals die from accidental, non-fire related CO poisoning with an average loss of 26 years of productivity accounting for $355 million, and 2800 are hospitalized with acute medical care costs of $33 million. Available data indicate that accidental CO poisoning in the US conservatively costs society over $1.3 billion, resulting from direct hospital costs and lost earnings. Further, it demonstrates a positive cost-benefit ratio for the uniform use of residential CO alarms. PMID:26844181

  5. Concurrent macular corneal dystrophy and keratoconus.

    PubMed

    Mohammad-Rabei, Hossein; Shojaei, Ahmad; Aslani, Mehdi

    2012-01-01

    A 21-year-old female presented with progressive bilateral visual loss for the past 8 years. The patient had no history of systemic disease, surgery or medications. Complete ophthalmologic examination and topography were performed. On ophthalmic examination, uncorrected visual acuity was counting fingers at 2.5 m (20/50 with pinhole) in the right and left eyes. Both corneas appeared hazy on gross examination. On slit-lamp biomicroscopy, focal grayish-white opacities with indistinct borders were noted in the superficial and deep corneal stroma of both eyes. Both corneas were thin and bulging. Corneal topography showed a pattern consistent with keratoconus. The patient underwent penetrating keratoplasty (PKP). Histopathologic studies after PKP confirmed the diagnosis of macular corneal dystrophy and keratoconus in the same eye. The patient was clinically diagnosed as a case of concurrent macular dystrophy and keratoconus, which is a very rare presentation.

  6. [Treatment of retinal detachment with macular hole].

    PubMed

    Pikulski, Z; Nawrocki, J; Dziegielewski, K

    1993-01-01

    The methods and results of surgery in 6 cases of retinal detachment with macular hole are presented. In all 6 cases pars plana vitrectomy was performed, in 4 with subsequent SF6 and in 2 with silicone oil tamponade. Retinal attachment was achieved in 4 eyes. Visual acuity 1/50-2/50 was found after surgery in 5 cases. The follow-up ranged from 6 to 9 months.

  7. [Treatment of retinal detachment with macular hole].

    PubMed

    Pikulski, Z; Nawrocki, J; Dziegielewski, K

    1993-06-01

    The authors presented 6 cases of macular hole retinal detachment in which pars plana vitrectomy with endo-tamponade was performed; in 4 cases SF6 gas and in 2, with PVR silicone oil was used. Retina was completely attached in 4 eyes. Visual acuity 1/50 to 2/50 was achieved in 5 eyes. Follow-up ranged from 5 to 9 months.

  8. Current Management of Traumatic Macular Holes.

    PubMed

    Liu, Wu; Grzybowski, Andrzej

    2017-01-01

    Traumatic macular hole (TMH) is not a rare clinical condition, especially in young population. Its prognosis is of complexity and uncertainty, with a relatively high rate of spontaneous closure in some cases. Modern vitrectomy surgery plays an important role in the treatment of TMH, although the functional outcomes may be compromised by the concomitant retinal pathologies. Decision-making about the time of vitrectomy, especially in pediatric patients, remains to be clarified further.

  9. Current Management of Traumatic Macular Holes

    PubMed Central

    Grzybowski, Andrzej

    2017-01-01

    Traumatic macular hole (TMH) is not a rare clinical condition, especially in young population. Its prognosis is of complexity and uncertainty, with a relatively high rate of spontaneous closure in some cases. Modern vitrectomy surgery plays an important role in the treatment of TMH, although the functional outcomes may be compromised by the concomitant retinal pathologies. Decision-making about the time of vitrectomy, especially in pediatric patients, remains to be clarified further. PMID:28239490

  10. Perceived quality of health care in macular disease: a survey of members of the Macular Disease Society

    PubMed Central

    Mitchell, J; Bradley, P; Anderson, S J; ffytche, T; Bradley, C

    2002-01-01

    Aim: To investigate the experiences of people with macular disease within the British healthcare system. Method: The Macular Disease Society Questionnaire, a self completion questionnaire designed to survey the experiences of people with macular disease, was sent to 2000 randomly selected members of the Macular Disease Society. The questionnaire incorporated items about people's experiences with health professionals and the information and support provided by them at the time of diagnosis and thereafter. Results: Over 50% thought their consultant eye specialist was not interested in them as a person and 40% were dissatisfied with their diagnostic consultation. 185 people thought their general practitioner (GP) was well informed about macular disease but twice as many people thought their GP was not well informed. About an equal number of people thought their GP was supportive as those who thought their GP was not supportive. A total of 1247 people were told “nothing can be done to help with your macular disease.” A number of negative emotional reactions were experienced by those people as a result, with 61% of them reporting feeling anxious or depressed. Of 282 people experiencing visual hallucinations after diagnosis with macular disease, only 20.9% were offered explanations for them. Conclusions: Many people with macular disease have unsatisfactory experiences of the healthcare system. Many of the reasons for dissatisfaction could be resolved by healthcare professionals if they were better informed about macular disease and had a better understanding of and empathy with patients' experiences. PMID:12084749

  11. Effect of topical isopropyl unoprostone on macular atrophy progression in eyes with exudative age-related macular degeneration

    PubMed Central

    Shiragami, Chieko; Miyake, Masahiro; Fujiwara, Atsushi; Morizane, Yuki; Tsujikawa, Akitaka; Yamashita, Ayana; Shiraga, Fumio

    2017-01-01

    Abstract Background: To evaluate the efficacy and safety of topical isopropyl unoprostone (IU) in treating macular atrophy in age-related macular degeneration (AMD) patients. Methods: Fifty-two AMD patients with macular atrophy were included and randomly assigned (1:1) to the treatment (topical 0.15% IU) or placebo group. Subjects used study eye drops 3 times a day for 54 weeks. The macular atrophy was documented on fundus autofluorescence photographs and measured using RegionFinder. The enlargement rate of macular atrophy and the changes in visual acuity were examined statistically between baseline and 54 weeks. Results: Forty-eight subjects were included in the analyses because 4 subjects withdrew from the study. The differences between the IU and placebo groups in mean and median area of macular atrophy were not statistically significant at baseline. The baseline median lesion size of macular atrophy was 2.33 mm2 in the IU group and 1.63 mm2 in the placebo group (P = 0.51). The intergroup difference in the enlargement ratio of macular atrophy (21 ± 15% in the IU group and 111 ± 96% in the placebo group) was statistically significant (P < 0.001). Additionally, visual acuity tended to improve over baseline in the IU group. No serious adverse events were observed. Conclusions: Topical IU therapy is safe and effective for treating macular atrophy in AMD patients. PMID:28328847

  12. Macular Bioaccelerometers on Earth and in Space

    NASA Technical Reports Server (NTRS)

    Ross, M. D.; Cutler, L.; Meyer, G.; Vazin, P.; Lam, T.

    1991-01-01

    Space flight offers the opportunity to study linear bioaccelerometers (vestibular maculas) in the virtual absence of a primary stimulus, gravitational acceleration. Macular research in space is particularly important to NASA because the bioaccelerometers are proving to be weighted neural networks in which information is distributed for parallel processing. Neural networks are plastic and highly adaptive to new environments. Combined morphological-physiological studies of maculas fixed in space and following flight should reveal macular adaptive responses to microgravity, and their time-course. Ground-based research, already begun, using computer-assisted, 3-dimensional reconstruction of macular terminal fields will lead to development of computer models of functioning maculas. This research should continue in conjunction with physiological studies, including work with multichannel electrodes. The results of such a combined effort could usher in a new era in understanding vestibular function on Earth and in space. They can also provide a rational basis for counter-measures to space motion sickness, which may prove troublesome as space voyager encounter new gravitational fields on planets, or must re-adapt to 1 g upon return to earth.

  13. Macular pigment Raman detector for clinical applications

    PubMed Central

    Ermakov, Igor; Ermakova, Maia; Gellermann, Werner; Bernstein, Paul S.

    2011-01-01

    Clinical studies of carotenoid macular pigments (MP) have been limited by the lack of noninvasive, objective instruments. We introduce a novel noninvasive optical instrument, an MP Raman detector, for assessment of the carotenoid status of the human retina in vivo. The instrument uses resonant excitation of carotenoid molecules in the visible wavelength range, and quantitatively measures the highly specific Raman signals that originate from the single- and double-bond stretch vibrations of the π-conjugated carotenoid molecule’s carbon backbone. The instrument is a robust, compact device and suitable for routine measurements of MP concentrations in a clinical setting. We characterized and tested the instrument in clinical studies of human subjects to validate its function and to begin to establish its role as a possible screening test for macular pathologies. We also show that the MP Raman spectroscopy technology has potential as a novel, highly specific method for rapid screening of carotenoid antioxidant levels in large populations at risk for vision loss from age-related macular degeneration, the leading cause of blindness of the elderly in the developed world. PMID:14715066

  14. Visual hallucinations in patients with macular degeneration.

    PubMed

    Holroyd, S; Rabins, P V; Finkelstein, D; Nicholson, M C; Chase, G A; Wisniewski, S C

    1992-12-01

    This study was undertaken to determine the prevalence of visual hallucinations in patients with macular degeneration, describe such hallucinations phenomenologically, and possibly determine factors predisposing to their development. Using a case-control design, the authors screened 100 consecutive patients with age-related macular degeneration for visual hallucinations. Each patient with visual hallucinations was matched to the next three patients without hallucinations. The patients and comparison subjects were compared in terms of scores on the Beck Depression Inventory, Eysenck Personality Questionnaire, Telephone Interview for Cognitive Status, and a structured questionnaire including demographic characteristics, family history, and medical and psychiatric history. Ophthalmologic data were obtained by chart review. Of the 100 patients, 13 experienced visual hallucinations. Four variables were significantly associated with having hallucinations: living alone, lower cognition score, history of stroke, and bilaterally worse visual acuity. Hallucinations were not associated with family or personal history of psychiatric disorder or with personality traits. In 11 (84.6%) of the 13 patients, the hallucinations had begun in association with an acute change in vision. These results indicate that visual hallucinations are prevalent among patients with macular degeneration. They appear unrelated to primary psychiatric disorder. The predisposing factors of bilaterally worse vision and living alone support an association with sensory deprivation, while history of stroke and worse cognition support a decreased cortical inhibition theory.

  15. Triage and Management of Accidental Laboratory Exposures to Biosafety Level-3 and -4 Agents

    PubMed Central

    Rodak, Colleen; Bray, Mike; Davey, Richard T.

    2009-01-01

    The recent expansion of biocontainment laboratory capacity in the United States has drawn attention to the possibility of occupational exposures to BSL-3 and -4 agents and has prompted a reassessment of medical management procedures and facilities to deal with these contingencies. A workshop hosted by the National Interagency Biodefense Campus was held in October 2007 and was attended by representatives of all existing and planned BSL-4 research facilities in the U.S. and Canada. This report summarizes important points of discussion and recommendations for future coordinated action, including guidelines for the engineering and operational controls appropriate for a hospital care and isolation unit. Recommendations pertained to initial management of exposures (ie, immediate treatment of penetrating injuries, reporting of exposures, initial evaluation, and triage). Isolation and medical care in a referral hospital (including minimum standards for isolation units), staff recruitment and training, and community outreach also were addressed. Workshop participants agreed that any unit designated for the isolation and treatment of laboratory employees accidentally infected with a BSL-3 or -4 pathogen should be designed to maximize the efficacy of patient care while minimizing the risk of transmission of infection. Further, participants concurred that there is no medically based rationale for building care and isolation units to standards approximating a BSL-4 laboratory. Instead, laboratory workers accidentally exposed to pathogens should be cared for in hospital isolation suites staffed by highly trained professionals following strict infection control procedures. PMID:19634998

  16. Accidental discharge of a Halon 1301 total flooding fire extinguishing system

    SciTech Connect

    Sass-Kortsak, A.M.; Holness, D.L.; Stopps, G.J.

    1985-11-01

    An accidental discharge of a total flooding Halon 1301 fire extinguishing system is described. The release of the Halon was accompanied by a sudden very loud noise, considerable air turbulence and a dense fog, resulting in worker anxiety and loss of visibility. The workers in the area at the time of the discharge reported higher frequencies of lightheadedness, headache, nasal complaints and disorientation than those entering the area later. Halon 1301 usually is regarded as having a low toxicity, although at concentrations above those used in occupied spaces, effects on consciousness and cardiac rhythm have been reported. In the present report no significant illness or injury due to the Halon exposure was found. A fine oily deposit found on horizontal surfaces in the area subsequent to the discharge consisted of mineral oil and iron, suggesting that this material was scoured out of the piping as the Halon discharged. The disorientation and anxiety produced by an accidental discharge can be minimized through education programs designed to ensure that personnel know what to expect and how to abort the discharge if it results from a false alarm. Situations leading to triggering of fire detectors by events other than fires should be investigated and reduced.

  17. Acute gastroduodenal injury after ingestion of diluted herbicide pendimethalin.

    PubMed

    Tsukada, K; Azuhata, H; Katoh, H; Kuwano, H

    2009-03-01

    The herbicide, pendimethalin, is used worldwide, but its acute toxicity is not yet widely known. There have been some reported acute pendimethalin poisoning cases in humans and most of them intentionally ingested the concentrated formulation. We describe a 73-year-old man who developed corrosive gastroduodenal injury after accidental ingestion of the diluted (300 times with water) pendimethalin formulation. He had a history of reflux oesophagitis and had been taking omeprazol (10 mg/day) for a year. He consumed alcohol two hours after the accidental ingestion and then had nausea and epigastric pain. Endoscopy performed three days post-exposure revealed gastroduodenal injury. As he had consumed alcohol every day for years and had no history of gastroduodenal ulcer, the accidental ingestion may be associated with this injury. He was successfully treated by increasing his dosage of omeprazol (20 mg/day) for two weeks. This case indicates that ingestion of a small quantity of pendimethalin can provoke gastroduodenal injury.

  18. Self limiting features of accidental criticality in a solution system

    SciTech Connect

    Malenfant, R.E.

    1988-01-01

    Experience with the SHEBA solution critical assembly during validation testing of accidental criticality alarm detectors provided several insights into the character of potential accidental excursions. Two observations were of particular interest. First, it is nearly impossible to maintain a solution system, particularly one employing low-enrichment material, in a constant state. If super-critical, the system will heat up, expand (or form bubbles), return to a sub-critical state, and shut down of its own accord without going into short period oscillations. Second, a very slow change in the system could produce a long ''pulse'' resulting in lengthy exposures, a high dose, but a low dose rate. The experiments dramatically contradicted the popular contention that accidental criticality is characterized by a blue flash, a clap of thunder, and violet expulsion of material. 5 refs., 3 figs., 4 tabs.

  19. Can Canister Containment Be Maintained After Accidental Drop Events?

    SciTech Connect

    D. K. Morton; S. D. Snow; T. E. Rahl; R. K. Blandford; T. J. Hill

    2006-05-01

    The National Spent Nuclear Fuel Program (NSNFP) has pursued a number of structural testing projects that are intended to provide data that can be used to substantiate the position that U. S. Department of Energy (DOE) spent nuclear fuel (SNF) canisters, made from austenitic stainless steels, can maintain containment after an accidental drop event and that plastic finite element methods can be used to accurately predict the structural response of canister configurations not specifically tested. In particular, drop tests of full-scale canisters and material impact testing at varying strain rates reflecting accidental drop conditions have been completed or are in progress. This paper provides insights to conclusions achieved to date and what efforts are planned to fully address the pertinent issues necessary to demonstrate the safety of DOE SNF canisters subjected to accidental drop events.

  20. Outcomes and predictive factors in bilateral macular holes.

    PubMed

    Chang, Emmanuel; Garg, Pooja; Capone, Antonio

    2013-09-01

    To evaluate the incidence, risk factors, outcomes, and visual prognosis in patients with bilateral macular holes repaired surgically with indocyanine green (ICG)-assisted internal limiting membrane (ILM) peeling in our population. Retrospective, multisurgeon, nonrandomized, noncomparative case series. Eighty-two patients were identified who underwent bilateral macular hole surgery with ILM peeling without other vision-limiting pathologic features. All patients underwent bilateral macular hole surgery at a single-site, multisurgeon center with preoperative and postoperative optical coherence tomography (OCT) characterization and ICG-assisted ILM peeling during surgery with intraocular gas tamponade. Comparison of the closure and reopening rate, prognosis, change in visual acuity, and family history for patients undergoing bilateral surgery. Eight-two patients met the inclusion criteria (164 eyes). Nineteen patients (22.6%) had asymptomatic vitreomacular adhesion by OCT in the fellow eye at the time of presentation of macular hole in the first eye. There was a mean interval of 19.4 months between the first and fellow eye macular holes and a male-to-female ratio of 1:2.42. Surgical closure rate was 89% with the first macular hole surgery and 98.8% with the second surgery. Sex, family history, and duration of hole symptom were not found to be associated with risk of macular hole recurrence. Symptom duration of less than 1 year and earlier macular hole stage yielded the best visual acuity after successful surgical repair. Patients with bilateral macular holes may consider undergoing bilateral macular hole surgery to improve visual acuity. Successful closure rates of bilateral macular holes with ILM peeling in this series are better than those reported previously without consistent ILM peeling. The author(s) have no proprietary or commercial interest in any materials discussed in this article. Copyright © 2013 American Academy of Ophthalmology. Published by Elsevier Inc

  1. [Management of hypothermia -- Severe Accidental Hypothermia Centre in Krakow].

    PubMed

    Darocha, Tomasz; Kosiński, Sylweriusz; Jarosz, Anna; Sobczyk, Dorota; Gałązkowski, Robert; Sanak, Tomasz; Hymczak, Hubert; Kapelak, Bogusław; Drwiła, Rafał

    2015-01-01

    Severe accidental hypothermia is a condition associated with significant morbidity and mortality. In the years 2009–2012 the Polish National Statistics Department reported 1836 deaths due to exposure to excessive natural cold. The Severe Accidental Hypothermia Centre (CLHG, Centrum Leczenia Hipotermii Glebokiej) was set up in Krakow in 2013. It is a unit functioning within the structure of the Cardiac Surgery Clinic, established in order to improve the effectiveness of the treatment of patients in the advanced stages of severe hypothermia. Early identification of hypothermia, binding algorithm and coordination leading to extracorporeal rewarming, are the most important elements in the deep hypothermia management.

  2. Scaling and gender behavior of road accidental dynamics

    NASA Astrophysics Data System (ADS)

    Qiu, Tian; Zou, Xiang-Xiang; Chen, Guang; Jiang, Xiong-Fei; Zhong, Li-Xin

    2014-12-01

    The probability distribution of the time intervals between two consecutive accidents is investigated, based on the road accidental records of the Great Britain. A universal description is obtained for different roads, by rescaling the probability distribution and time intervals. The scaling curve is found to deviate from the Gaussian distribution, but it is well fitted by a stretched exponential function. Long-range time correlation is revealed for the interevent series. Moreover, gender similarity is found for the small accidental intervals, while for the large intervals, the female drivers are observed to present a higher probability than the male drivers.

  3. Herb-induced cardiotoxicity from accidental aconitine overdose

    PubMed Central

    Sheth, Sujata; Tan, Elaine Ching Ching; Tan, Hock Heng; Tay, Leslie

    2015-01-01

    Patients who overdose on aconite can present with life-threatening ventricular arrhythmia. Aconite must be prepared and used with caution to avoid cardiotoxic effects that can be fatal. We herein describe a case of a patient who had an accidental aconite overdose but survived with no lasting effects. The patient had prepared Chinese herbal medication to treat his pain, which resulted in an accidental overdose of aconite with cardiotoxic and neurotoxic effects. The patient had ventricular tachycardia, bidirectional ventricular tachycardia and ventricular fibrillation. Following treatment with anti-arrhythmic medications, defibrillation and cardiopulmonary resuscitation, he made an uneventful recovery, with no further cardiac arrhythmias reported. PMID:26243980

  4. Accidental human injection of Excenel RTU: ceftiofur hydrochloride in cottonseed oil.

    PubMed

    Gwynne-Jones, David; Lyall, Patrick; Hung, Noelyn A; Meikle, Grant

    2008-11-01

    There is little knowledge within the medical community of the existence of veterinary antibiotics in oil-based suspensions and the adverse effects that may occur with accidental human injection. A farmer injected an unknown quantity of Excenel RTU into her right thigh. Despite early debridement she developed a deep infection and recurrent chronic inflammation in the subcutaneous tissues and muscle secondary to the cottonseed oil suspension. Radical debridement and extensive split skin grafting was required but she still has had recurrences 12 months after injury. Prompt surgical debridement should be performed as in cases of oil based veterinary vaccines. Despite being an antibiotic there is a significant risk of infection from a dirty needle following inoculation and multiple cultures should be taken and appropriate broad spectrum antibiotics used. Radical debridement and skin grafting necessitating specialist plastic surgical attention may be required.

  5. Cardiac thrombus developing after an accidental high-voltage electric shock in a child.

    PubMed

    Akın, Alper; Bilici, Meki; Demir, Fikri; Gözü Pirinççioğlu, Ayfer; Yavuz, Celal

    2015-01-01

    Electric shock is a condition that may affect various organ systems and potentially cause death. Cardiac findings vary from asymptomatic mild injury to fatal myocardial involvement. Herein we present a five-year-old boy with a cardiac thrombus developing after an accidental electrical shock. Cardiac arrhythmias and evidence of ischemia have been reported after electric shock; we were, however, unable to identify an earlier case report of intracardiac thrombosis related to electric shock. Findings such as elevated cardiac enzymes and systolic dysfunction, which indicate myocardial damage following electric shock, were present in our patient. We think that the cardiac thrombus might have resulted from the myocardial damage and the slowed intracardiac blood flow related to systolic dysfunction. As the thrombus was thought to have been formed through known mechanisms, it was treated traditionally. However, further data regarding the etiology and management of such thrombi is needed.

  6. [Secondary medullary aplasia from accidental radiation:therapeutic options and evolution of the concept].

    PubMed

    de Revel, T; Fagot, T; Souleau, B; Dormont, D; Nedellec, G

    2002-07-01

    Bone marrow grafting following accidental irradiation exposure should be viewed in the perspective of a severe myeloablative syndrome linked to high medullary damage for a dose range higher than 6-8 Gy, resulting in very late or no recovery. Prognosis will depend on the presence or absence of radio-combined injuries, the toxicity of the transplant procedure, and the risk of rejection induced by insufficient percritical immunosuppression. It is in this context that new cell therapy modalities, which combine enhanced peripheral hematopoietic cell engraftment and high immunosuppressive conditioning regimen with low extrahematological toxicity, inducing early and stable mixed lymphomyeloid chimerism with minimal morbidity, can be considered. Such an approach is being evaluated in the treatment of patients with hematological malignancies at high risk of transplant-related mortality using conventional bone marrow methods.

  7. Hospital-based screening tools in the identification of non-accidental trauma.

    PubMed

    Gonzalez, Dani O; Deans, Katherine J

    2017-02-01

    Over 700,000 children are victims of abuse and neglect each year in the United States. Effective screening programs that entail broad capture of suspected non-accidental trauma (NAT) may help to identify sentinel injuries. This can facilitate earlier detection and psychosocial interventions in hopes of decreasing recurrent NAT, which confers a higher mortality rate. The purpose of this article is to outline essential components of hospital-based NAT screening tools and highlight existing programs. In general, these tools should include several components: education sessions for healthcare providers on how to identify signs of NAT, automated notes or checklists within the electronic medical record to prompt specialty referrals, and a multidisciplinary team of experts that can address the needs of these children in the acute care setting. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Complications following an accidental sodium hypochlorite extrusion: A report of two cases.

    PubMed

    Bosch-Aranda, María L; Canalda-Sahli, Carlos; Figueiredo, Rui; Gay-Escoda, Cosme

    2012-07-01

    Sodium hypochlorite (NaOCl) is the most commonly used solution in root canal treatments, as it is a low-cost method that displays a very effective antimicrobial activity against microbiota of infected root canals. However, this solution can cause complications especially due to its cytotoxic features. When this solution is injected into the adjacent tissues, the patient usually experiences intense pain, and an urgent treatment should be implemented in order to prevent a long-term sequelae. This paper describes the clinical features of two patients that experienced an accidental extrusion of NaOCl after endodontic treatment of varying severity and with different treatments. Furthermore, it shows the long-term neurologic injuries that this type of accidents may cause and a treatment protocol for these situations will be suggested. Key words:Nerve damage, root canal irrigation, root canal treatment, sodium hypochlorite.

  9. Complications following an accidental sodium hypochlorite extrusion: A report of two cases

    PubMed Central

    Bosch-Aranda, María L.; Canalda-Sahli, Carlos; Gay-Escoda, Cosme

    2012-01-01

    Sodium hypochlorite (NaOCl) is the most commonly used solution in root canal treatments, as it is a low-cost method that displays a very effective antimicrobial activity against microbiota of infected root canals. However, this solution can cause complications especially due to its cytotoxic features. When this solution is injected into the adjacent tissues, the patient usually experiences intense pain, and an urgent treatment should be implemented in order to prevent a long-term sequelae. This paper describes the clinical features of two patients that experienced an accidental extrusion of NaOCl after endodontic treatment of varying severity and with different treatments. Furthermore, it shows the long-term neurologic injuries that this type of accidents may cause and a treatment protocol for these situations will be suggested. Key words:Nerve damage, root canal irrigation, root canal treatment, sodium hypochlorite. PMID:24558554

  10. Solar radiation and age-related macular degeneration.

    PubMed

    Young, R W

    1988-01-01

    Age-related macular degeneration (AMD) involves a progressive impairment of the outer layers in the center of the retina. Experimental studies have demonstrated that bright light preferentially damages precisely the region that degenerates in AMD. The evidence that solar radiation is responsible for some of the deteriorative changes that lead to AMD is examined in this review. In the primate eye, the high-energy portion of the solar spectrum is most hazardous to retinal molecules, with damaging effects increasing as photon energy rises. This action spectrum is explicable by the quantum laws which describe the interaction of radiation with matter. High-energy visible and ultraviolet photons can produce molecular damage by a photochemical mechanism. The lesion is exacerbated by oxygen, which initiates free-radical chain reactions (photodynamic effects). Melanin exerts a protective effect against damage from sunlight. In the human retina, documented lesions from solar radiation range from the acute effects of sun-gazing to injuries resulting from prolonged periods of exposure in brightly illuminated environments. The damage occurs in the same region that degenerates in AMD. A cataractous lens and ocular melanin both protect the retina against AMD, as predicted by the radiation hypothesis. Identification of an environmental factor that evidently plays a role in the etiology of AMD provides the basis for a program of preventive medicine.

  11. [Depression in Patients with Age-Related Macular Degeneration].

    PubMed

    Narváez, Yamile Reveiz; Gómez-Restrepo, Carlos

    2012-09-01

    Age-related macular degeneration is a cause for disability in the elderly since it greatly affects their quality of life and increases depression likelihood. This article discusses the negative effect depression has on patients with age-related macular degeneration and summarizes the interventions available for decreasing their depression index.

  12. Risk Factors Associated with Suicide Attempts and Other Self-Injury among Hong Kong Adolescents

    ERIC Educational Resources Information Center

    Wong, Joy P. S.; Stewart, Sunita M.; Ho, S. Y.; Lam, T. H.

    2007-01-01

    This study examined 1,361 Chinese adolescents who reported self-injurious behaviors. Groups A and B both acknowledged deliberate self-injury, but only Group A had made a suicide attempt. Group C reported accidental self-injury. Deliberate self-injurers (Groups A and B) were more frequently girls, older, and with more suicidal ideation. Group A had…

  13. Accidental exposures to blood and body fluids among health care workers in dental teaching clinics: a prospective study.

    PubMed

    Ramos-Gomez, F; Ellison, J; Greenspan, D; Bird, W; Lowe, S; Gerberding, J L

    1997-09-01

    The authors evaluated accidental exposures to blood and body fluids reported to a hotline or to health officials at four dental teaching clinics. The authors used a standard questionnaire to solicit and record data regarding each exposure. During a 63-month period, 428 parenteral exposures to blood or body fluids were documented. Dental students and dental assistants had the highest rates of exposure. Syringe needle injuries were the most common type of exposure, while giving injections, cleaning instruments after procedures and drilling were the activities most frequently associated with exposures.

  14. Measurement of macular pigment optical density in a healthy chinese population sample

    USDA-ARS?s Scientific Manuscript database

    Macular pigment may protect against age-related macular degeneration (AMD) by its capability to absorb blue light and scavenge free radicals. Current information on human macular pigment density has been largely from studies on Caucasians populations. The purpose of this study was to assess macular ...

  15. Chronic Traumatic Giant Macular Hole Repair with Autologous Platelets

    PubMed Central

    Makkouk, Fuad; Picciani, Renata; Godley, Bernard; Elkeeb, Ahmed

    2017-01-01

    We report on the closure of a chronic posttraumatic giant macular hole. The patient presented with decreased vision in the left eye following blunt trauma 20 years prior. His dilated fundus examination revealed a 3000 um base-diameter full thickness macular hole. Surgical repair was performed with pars plana vitrectomy (PPV), internal limiting membrane peeling and autologous platelet concentrate (APC) injected over the macular hole. At one month follow-up, the macular hole had closed on exam and optical coherence tomography (OCT), and the patient reported subjective visual improvement. To our knowledge, this report presents the first case of a chronic giant macular hole successfully closed after undergoing surgery with adjuvant platelets therapy. PMID:28168133

  16. Acetazolamide for cystoid macular oedema in Bietti crystalline retinal dystrophy.

    PubMed

    Broadhead, Geoffrey K; Chang, Andrew A

    2014-04-01

    Bietti crystalline retinal dystrophy is a rare, inherited disorder whose hallmark is the presence of retinal crystal deposits associated with later chorioretinal degeneration. This condition may rarely be complicated by the development of cystoid macular oedema leading to rapid visual decline. Currently, treatment options for this complication of Bietti dystrophy are limited and the visual prognosis is poor. Here, we present a case of cystoid macular oedema associated with Bietti dystrophy that was successfully diagnosed using multimodal imaging techniques including optical coherence tomography and fluorescein angiography. These modalities confirmed the diagnosis of macular oedema and excluded other possible causes of oedema such as choroidal neovascularisation. In this patient, cystoid macular oedema was resolved with oral acetazolamide therapy, a treatment that has not been previously reported in this context. Acetazolamide treatment resulted in oedema resolution and improvement in visual function, and can be considered a therapeutic option for other patients with Bietti dystrophy who develop cystoid macular oedema.

  17. Indocyanine green toxicity after macular hole surgery in both eyes.

    PubMed

    Kim, Kyu Seop; Lee, Won Ki

    2012-01-01

    To report on a patient with bilateral macular holes who developed circular retinal pigment epithelial atrophy at the fovea after macular hole surgery using indocyanine green in both eyes. Interventional case report. A 68-year-old woman presented with a Stage 3 macular hole in each eye. Complete pars plana vitrectomy with indocyanine green-assisted internal membrane peeling was performed. The procedures were uneventful. The concentration and the exposure time to intravitreal indocyanine green were tolerable. One month after surgery, the macular hole was closed, but underlying circular retinal pigment epithelial atrophy was observed in both eyes. In clinical practice, if indocyanine green-related ocular toxicity develops in one eye after macular hole surgery, care should be taken regarding indocyanine green use during surgery of the other eye.

  18. Chronic Traumatic Giant Macular Hole Repair with Autologous Platelets.

    PubMed

    Coca, Mircea; Makkouk, Fuad; Picciani, Renata; Godley, Bernard; Elkeeb, Ahmed

    2017-01-05

    We report on the closure of a chronic posttraumatic giant macular hole. The patient presented with decreased vision in the left eye following blunt trauma 20 years prior. His dilated fundus examination revealed a 3000 um base-diameter full thickness macular hole. Surgical repair was performed with pars plana vitrectomy (PPV), internal limiting membrane peeling and autologous platelet concentrate (APC) injected over the macular hole. At one month follow-up, the macular hole had closed on exam and optical coherence tomography (OCT), and the patient reported subjective visual improvement. To our knowledge, this report presents the first case of a chronic giant macular hole successfully closed after undergoing surgery with adjuvant platelets therapy.

  19. 49 CFR 192.751 - Prevention of accidental ignition.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 3 2010-10-01 2010-10-01 false Prevention of accidental ignition. 192.751 Section 192.751 Transportation Other Regulations Relating to Transportation (Continued) PIPELINE AND HAZARDOUS... NATURAL AND OTHER GAS BY PIPELINE: MINIMUM FEDERAL SAFETY STANDARDS Maintenance § 192.751 Prevention of...

  20. Accidental introductions of natural enemies: causes and implications

    USDA-ARS?s Scientific Manuscript database

    Accidental introductions of natural enemies, including parasitoid and predatory groups, may exceed species introduced intentionally. Several factors favor this: a general surge in international trade; lack of surveillance for species that are not associated with live plants or animals; inability to ...

  1. Accidental Ingestion of Endodontic File: A Case Report

    PubMed Central

    Saraf, Hrushikesh P.; Nikhade, Pradnya P.; Chandak, Manoj G.

    2012-01-01

    Ingestion of the endodontic instrument during root canal treatment is rare but can result in serious complications. The present paper reports a case in which endodontic file was accidentally swallowed by the patient undergoing root canal therapy, which entered digestive tract and passed uneventfully. PMID:22577586

  2. The Accidental Transgressor: Morally-Relevant Theory of Mind

    ERIC Educational Resources Information Center

    Killen, Melanie; Mulvey, Kelly Lynn; Richardson, Cameron; Jampol, Noah; Woodward, Amanda

    2011-01-01

    To test young children's false belief theory of mind in a morally relevant context, two experiments were conducted. In Experiment 1, children (N=162) at 3.5, 5.5, and 7.5 years of age were administered three tasks: prototypic moral transgression task, false belief theory of mind task (ToM), and an "accidental transgressor" task, which measured a…

  3. 49 CFR 192.751 - Prevention of accidental ignition.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 3 2013-10-01 2013-10-01 false Prevention of accidental ignition. 192.751 Section 192.751 Transportation Other Regulations Relating to Transportation (Continued) PIPELINE AND HAZARDOUS... NATURAL AND OTHER GAS BY PIPELINE: MINIMUM FEDERAL SAFETY STANDARDS Maintenance § 192.751 Prevention of...

  4. Accidental Childhood Poisoning in Enugu, South-East, Nigeria

    PubMed Central

    Edelu, BO; Odetunde, OI; Eke, CB; Uwaezuoke, NA; Oguonu, T

    2016-01-01

    Background: Accidental childhood poisoning is one of the recognized causes of morbidity and mortality in children under the age of 5 years worldwide. The prevalence and type of substance ingested vary from place to place and over time. Aim: This study was conducted with the aim of ascertaining the frequency and pattern of accidental childhood poisoning in Enugu. Subjects and Methods: This retrospective study was conducted at the Emergency Paediatric Unit of the University of Nigeria Teaching Hospital, Enugu, South-East, Nigeria from January 2003 to December 2012 (10 years). All the cases of childhood accidental poisoning that presented within the period were reviewed and important information extracted. Results: Sixty-five cases of childhood poisoning were recorded during the 10-year period, giving an incidence rate of 442 per 100,000 children. The mean age was 22.15 ± 11.7 months. Male:female ratio was 1.5:1. The prevalence was higher among those with low socioeconomic background. Kerosene poisoning was the most common agent. The overall mortality rate was 3.1% (2/65). Conclusion: Accidental childhood poisoning is common in Enugu, with appreciable mortality, with kerosene being the most common agent. We advocate regulatory policy on proper ways of storing kerosene and other harmful household chemicals and medications. PMID:27398248

  5. 49 CFR 192.751 - Prevention of accidental ignition.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 3 2011-10-01 2011-10-01 false Prevention of accidental ignition. 192.751 Section 192.751 Transportation Other Regulations Relating to Transportation (Continued) PIPELINE AND HAZARDOUS... NATURAL AND OTHER GAS BY PIPELINE: MINIMUM FEDERAL SAFETY STANDARDS Maintenance § 192.751 Prevention...

  6. The Accidental Transgressor: Morally-Relevant Theory of Mind

    ERIC Educational Resources Information Center

    Killen, Melanie; Mulvey, Kelly Lynn; Richardson, Cameron; Jampol, Noah; Woodward, Amanda

    2011-01-01

    To test young children's false belief theory of mind in a morally relevant context, two experiments were conducted. In Experiment 1, children (N=162) at 3.5, 5.5, and 7.5 years of age were administered three tasks: prototypic moral transgression task, false belief theory of mind task (ToM), and an "accidental transgressor" task, which measured a…

  7. The Accidental Transgressor: Morally Relevant Theory of Mind

    PubMed Central

    Killen, Melanie; Mulvey, Kelly Lynn; Richardson, Cameron; Jampol, Noah

    2014-01-01

    To test young children’s false belief theory of mind in a morally relevant context, two experiments were conducted. In Experiment 1, children (N = 162) at 3.5, 5.5, and 7.5 years of age were administered 3 tasks: prototypic moral transgression task, false belief theory of mind task (ToM), and an “accidental transgressor” task, which measured a morally relevant false belief theory of mind (MoToM). Children who did not pass false belief ToM were more likely to attribute negative intentions to an accidental transgressor than children who passed false belief ToM, and to use moral reasons when blaming the accidental transgressor. In Experiment 2, children (N = 46) who did not pass false belief ToM viewed it as more acceptable to punish the accidental transgressor than did participants who passed false belief ToM. Findings are discussed in light of research on the emergence of moral judgment and theory of mind. PMID:21377148

  8. Accidental nuclear war--a post-cold war assessment.

    PubMed

    Forrow, L; Blair, B G; Helfand, I; Lewis, G; Postol, T; Sidel, V; Levy, B S; Abrams, H; Cassel, C

    1998-04-30

    In the 1980s, many medical organizations identified the prevention of nuclear war as one of the medical profession's most important goals. An assessment of the current danger is warranted given the radically changed context of the post-Cold War era. We reviewed the recent literature on the status of nuclear arsenals and the risk of nuclear war. We then estimated the likely medical effects of a scenario identified by leading experts as posing a serious danger: an accidental launch of nuclear weapons. We assessed possible measures to reduce the risk of such an event. U.S. and Russian nuclear-weapons systems remain on a high-level alert status. This fact, combined with the aging of Russian technical systems, has recently increased the risk of an accidental nuclear attack. As a conservative estimate, an accidental intermediate-sized launch of weapons from a single Russian submarine would result in the deaths of 6,838,000 persons from firestorms in eight U.S. cities. Millions of other people would probably be exposed to potentially lethal radiation from fallout. An agreement to remove all nuclear missiles from high-level alert status and eliminate the capability of a rapid launch would put an end to this threat. The risk of an accidental nuclear attack has increased in recent years, threatening a public health disaster of unprecedented scale. Physicians and medical organizations should work actively to help build support for the policy changes that would prevent such a disaster.

  9. Corrosive acid injury of the stomach.

    PubMed

    Wijeratne, T; Ratnatunga, C; Dharrmapala, A; Samarasinghe, T

    2015-03-01

    Ingestion of corrosives with accidental or suicidal intent is a common problem in Sri Lanka. Management options and outcomes of corrosive injuries on stomach are not well documented in our setting. The clinical presentation, complications and management outcomes of nine patients with corrosive injury to stomach are presented. Gastric outlet obstruction seen in majority, was managed with bypass procedure (n=5) or resection (n=4). The outcomes of management were successful with both methods.

  10. Accidental exposures to blood and body fluids among health care workers in a Referral Hospital of Cameroon.

    PubMed

    Nouetchognou, Julienne Stéphanie; Ateudjieu, Jérôme; Jemea, Bonaventure; Mbanya, Dora

    2016-02-15

    Accidental exposure to blood and body fluids is a public health concern, especially among health workers and constitutes a risk of transmission of blood-borne viruses including HIV, hepatitis B virus and hepatitis C virus. The objective of this study was to determine the frequency and the post exposure management of accidental exposures to blood and body fluid among health workers in the Yaoundé University Teaching Hospital. It was a cross-sectional hospital-based study conducted from the 1st to the 30th of September 2013. Self-administered questionnaires to health workers were used to collect data on self-reported accidents, circumstances and post-exposure management. Their knowledge on accidental exposure to blood was also assessed. Data were entered and analyzed using Epi Info software version 3.5.4. Descriptive analysis was performed to measure the importance of AEB and to evaluate the risk of contamination. One hundred and fifty health workers were interviewed among which 36.7 % reported having been exposed to blood and body fluid at least once in the preceding 3 months. Splash was the most reported injury (in 60.3 % of cases), followed by needle stick (28.7 %) and cuts (10.9 %). Moreover, 43.6 % of victims were not vaccinated against HBV, 7.3 % were not wearing gloves during the accident and 41 % of splash occurs on injured skin. The majority of victims belong to the surgical Department [20 %, p = 0.2310]. None of these injuries had been reported in the registry of accidental exposure to blood. There is a high rate of accidental exposure to blood and body fluid in the daily hospital routine. Preventives measures, including wearing of protective equipment's during care and vaccination against HBV are not systematically done among health workers. Health institution should develop and provide standard operating procedures targeting surveillance of occupational risks, staff training, and supervision.

  11. Hunting stand-related injuries in orthopedics.

    PubMed

    Lebus, George F; Krueger, Chad A; Stinner, Daniel J; Mir, Hassan R

    2014-09-01

    Hunting remains an extremely popular recreational activity, with nearly 15 million Americans receiving a hunting license annually. Precautions have helped decrease accidents, but hunting-related injuries remain relatively common. The majority of severe, hunting-related accidents involve either a fall from a hunting platform or an accidental shooting. Both of these mechanisms frequently result in orthopedic injuries, many of which require operative care. Although firearms-associated injury has seemingly decreased, hunting platform falls and their sequelae are increasing. Understanding the mechanisms of these injuries and increasing awareness of them may minimize their morbidity and mortality or help prevent them altogether.

  12. Episcleral macular buckling for posterior retinal detachment in silicone oil filled eyes associated with myopic macular hole

    PubMed Central

    Tian, Jiao; Tang, Luo-Sheng; Guo, Xiao-Jian; Luo, Yong-Heng

    2013-01-01

    AIM To evaluate anatomical and visual outcomes of episcleral macular buckling (EMB) for posterior retinal detachment in silicone oil filled eyes associated with myopic macular hole. METHODS Five cases of EMB for initial failure of retinal reattachment after internal limiting membrane (ILM) peeling and silicone oil tamponade caused by myopic macular hole were retrospectively reviewed. A silicone sponge sutured directly across the macular region was performed on the silicone oil filled eyes. Silicone oil was removed no sooner than 1 month post-EMB. The duration of follow-up time after removal of silicone oil was more than 3 months. RESULTS Retinas of five eyes were all reattached at the last follow-up. The postoperative vision ranged from counting fingers to 0.08. CONCLUSION Anatomical results improved after EBM for posterior retinal detachment in silicone oil filled eyes associated with myopic macular hole, which was not evident for visual outcome. PMID:23638417

  13. [Treatment of pediatric traumatic macular holes].

    PubMed

    Štěpánková, J; Dotřelová, D

    2015-01-01

    To report the results of treatment of the traumatic macular holes (TMH) in four children. Retrospective study analyzed data of 4 children, males with a mean age of 12.3 years (range, 9-17 years), with diagnosis of TMH. All patients suffered a blunt trauma of the eye during the sport activities. The symptoms of three patients began after being hit to the face with a soccer balls, one boy was hit to his eye by a tennis rocket. Right eyes and left eyes were occurred identically. All patients were followed with ophthalmic examination, fundus photography and optical coherence tomography (OCT). One patient aged 10 years two weeks after blunt trauma with a soccer ball achieved spontaneous closure of TMH. Three patients aged nine to 17 years with TMH underwent surgical repair between September 2007 and May 2012 with three-port vitrectomy. After induction of posterior vitreous detachment vitrectomy with or without internal limiting membrane (ILM) peeling and gas or silicone oil injection were performed followed by prone positioning of head for ten days. Silicon oil was in an only patient removed within 3.5 month. All four macular holes were closed successfully. Follow-up period was from 10 to 31 month (ranged, 20 month). There were no reoperations. There were no surgical complications during follow-up period. Visual acuity (VA) improved in all eyes. In spontaneously closed TMH was VA improved from 0.5 to 1.0. In surgically treated group VA improved from initial 0.016 to 0.1 (ranged, 0.061) to final 0.25 to 0.5 (ranged, 0.36). Pars plana vitrectomy is a safe method for treatment TMH in children without tends to spontaneous closure of TMD in OCT imaging. Predisposition for TMH in population south-east Asia is suspected.Key words: traumatic macular hole, children, optical coherence tomography, vitrectomy, spontaneous closure.

  14. Preserved retinotopic brain connectivity in macular degeneration.

    PubMed

    Haak, Koen V; Morland, Antony B; Rubin, Gary S; Cornelissen, Frans W

    2016-05-01

    The eye disease macular degeneration (MD) is a leading cause of blindness worldwide. There is no cure for MD, but several promising treatments aimed at restoring vision at the level of the retina are currently under investigation. These treatments assume that the patient's brain can still process appropriately the retinal input once it is restored, but whether this assumption is correct has yet to be determined. We used functional magnetic resonance imaging (fMRI) and connective field modelling to determine whether the functional connectivity between the input-deprived portions of primary visual cortex (V1) and early extrastriate areas (V2/3) is still retinotopically organised. Specifically, in both patients with juvenile macular degeneration and age-matched controls with simulated retinal lesions, we assessed the extent to which the V1-referred connective fields of extrastriate voxels, as estimated on the basis of spontaneous fMRI signal fluctuations, adhered to retinotopic organisation. We found that functional connectivity between the input-deprived portions of visual areas V1 and extrastriate cortex is still largely retinotopically organised in MD, although on average less so than in controls. Patients with stable fixation exhibited normal retinotopic connectivity, however, suggesting that for the patients with unstable fixation, eye-movements resulted in spurious, homogeneous signal modulations across the entire input-deprived cortex, which would have hampered our ability to assess their spatial structure of connectivity. Despite the prolonged loss of visual input due to MD, the cortico-cortical connections of input-deprived visual cortex remain largely intact. This suggests that the restoration of sight in macular degeneration can rely on a largely unchanged retinotopic representation in early visual cortex following loss of central retinal function. © 2016 The Authors Ophthalmic and Physiological Optics published by John Wiley & Sons Ltd on behalf of

  15. [Age-related macular degeneration (AMD)].

    PubMed

    Michels, Stephan; Kurz-Levin, Malaika

    2009-03-01

    Today age-related macular degeneration (AMD) is the most frequent cause for legal blindness in western industrialized countries. The prevalence of this disease rises with increasing age. A multifactorial pathogenesis of AMD is postulated including genetic predisposition and environmental risk factors. The most relevant modifiable risk factor is smoking. Up to today there is no cure of this chronic disease. Prophylaxis, including a healthy diet and antioxidants as nutrional supplements for selected patients, aims to slow down the disease progression. Significant progress has been made in the treatment of the neovascular form of the disease using inhibitors of the vascular endothelial growth factor (VEGF).

  16. Diabetic Retinopathy and Diabetic Macular Edema.

    PubMed

    Cohen, Steven R; Gardner, Thomas W

    2016-01-01

    Diabetic retinopathy and diabetic macular edema result from chronic damage to the neurovascular structures of the retina. The pathophysiology of retinal damage remains uncertain but includes metabolic and neuroinflammatory insults. These mechanisms are addressed by intensive metabolic control of the systemic disease and by the use of ocular anti-inflammatory agents, including vascular endothelial growth factor inhibitors and corticosteroids. Improved understanding of the ocular and systemic mechanisms that underlie diabetic retinopathy will lead to improved means to diagnose and treat retinopathy and better maintain vision.

  17. Reduced Macular Vascular Density in Myopic Eyes

    PubMed Central

    Fan, Hua; Chen, Hao-Yu; Ma, Hong-Jie; Chang, Zheng; Yin, Hai-Quan; Ng, Danny Siu-Chun; Cheung, Carol Y; Hu, Shan; Xiang, Xiang; Tang, Shi-Bo; Li, Shuang-Nong

    2017-01-01

    Background: Morphological changes of the vasculature system in patients with myopia have been observed by Doppler ultrasound and fundus fluorescein angiography (FFA); however, these studies have limitations. Doppler ultrasound provides low-resolution images which are mainly obtained from visualized large vessels, and FFA is an invasive examination. Optic coherence tomography (OCT) angiography is a noninvasive, high-resolution measurement for vascular density. The purpose of this study was to investigate the change of vascular density in myopic eyes using OCT angiography. Methods: This cross-sectional study includes a total of 91 eyes from 47 participants including control, moderate, and high myopia that were evaluated by OCT angiography. Patients with myopia were recruited from the Refractive Department, Shenzhen Aier Eye Hospital, from August 5, 2015 to April 1, 2016. Emmetropic eyes were from healthy volunteers. The vascular density at macula and optic disc regions, ganglion cell complex (GCC) thickness, and retinal nerve fiber layer (RNFL) thickness were measured. Their relationships with axial length (AL) and refractive error were analyzed. One-way analysis of variance (ANOVA), Pearson's correlation, and generalized estimating equation were used for statistical analysis. Results: Both superficial and deep macular vascular density were highest in control (25.64% ± 3.76% and 37.12% ± 3.66%, respectively), then in moderate myopia (21.15% ± 5.33% and 35.35% ± 5.50%, respectively), and lowest in high myopia group (19.64% ± 3.87% and 32.81% ± 6.29%, respectively) (F = 13.74 and 4.57, respectively; both P < 0.001). Both superficial (β = −0.850 and 0.460, respectively) and deep (β = −0.766 and 0.396, respectively) macular vascular density were associated with AL and spherical equivalent (all P < 0.001). Superficial macular vascular density was associated with GCC thickness (β = 0.244, P = 0.040), independent of spherical equivalent. The vascular density in

  18. Depression in Age-Related Macular Degeneration.

    PubMed

    Casten, Robin; Rovner, Barry

    2008-01-01

    Age-related macular degeneration (AMD) is a major cause of disability in the elderly, substantially degrades the quality of their lives, and is a risk factor for depression. Rates of depression in AMD are substantially greater than those found in the general population of older people, and are on par with those of other chronic and disabling diseases. This article discusses the effect of depression on vision-related disability in patients with AMD, suggests methods for screening for depression, and summarizes interventions for preventing depression in this high-risk group.

  19. 40 CFR 63.95 - Additional approval criteria for accidental release prevention programs.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... accidental release prevention programs. 63.95 Section 63.95 Protection of Environment ENVIRONMENTAL... Additional approval criteria for accidental release prevention programs. (a) A State submission for approval... (“federally-listed chemicals”) that an approvable State Accidental Release Prevention program is regulating...

  20. Accidental Nuclear War: The Growing Peril. Part I [and] Part II.

    ERIC Educational Resources Information Center

    Newcombe, Alan, Ed.

    1984-01-01

    Two volumes designed to increase awareness of accidental nuclear war dangers are presented. The first of 5 sections in volume I proposes that although accidental war is preventable, the current arms race and secrecy about accidents and false alarms increase the possibility of an accidental war. Section 2 posits that decreased decision-making time…

  1. Accidental Nuclear War: The Growing Peril. Part I [and] Part II.

    ERIC Educational Resources Information Center

    Newcombe, Alan, Ed.

    1984-01-01

    Two volumes designed to increase awareness of accidental nuclear war dangers are presented. The first of 5 sections in volume I proposes that although accidental war is preventable, the current arms race and secrecy about accidents and false alarms increase the possibility of an accidental war. Section 2 posits that decreased decision-making time…

  2. Acute Macular Neuroretinopathy Associated With Chikungunya Fever.

    PubMed

    Pang, Claudine E; Navajas, Eduardo V; Warner, Simon J; Heisler, Morgan; Sarunic, Marinko V

    2016-06-01

    A 47-year-old man with recent travel to the Caribbean was admitted with acute febrileillness associated with arthralgia and skin rash followed by sudden onset of bilateral visual field defects. Funduscopy revealed subtle bilateral paracentral dark lesions nasal to the fovea best seen on near infrared imaging as hyporeflective, wedge-shaped, paracentral macular lesions. Spectral-domain optical coherence tomography (SD-OCT) through the lesions revealed hyperreflective bands at the level of the outer plexiform layer and outer nuclear layer (ONL), with concomitant attenuation of the underlying external limiting membrane (ELM), ellipsoid zone (EZ), and interdigitation zone (IZ). Neither fluorescein angiography nor speckle variance OCT angiography (sv-OCTA) showed any defects in retinal circulation. Work up revealed positive Immunoglobulin M for Chikungunya virus (CHIKV). Six months later, the patient had persistent scotomas, although reduced in size. SD-OCT showed subtle ONL thinning and restoration of the ELM, although EZ and IZ remained disrupted. Chikungunya fever may manifest as bilateral acute macular neuroretinopathy (AMN). Clinicians should be aware of possible systemic associations of AMN. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:596-599.]. Copyright 2016, SLACK Incorporated.

  3. PREFERRED RETINAL LOCUS IN MACULAR DISEASE

    PubMed Central

    GREENSTEIN, VIVIENNE C.; SANTOS, RODRIGO A. V.; TSANG, STEPHEN H.; SMITH, R. THEODORE; BARILE, GAETANO R.; SEIPLE, WILLIAM

    2009-01-01

    Purpose To investigate the location and fixation stability of preferred retinal locations (PRLs) in patients with macular disease, and the relationship among areas of abnormal fundus autofluorescence, the PRL and visual sensitivity. Methods Fifteen patients (15 eyes) were studied. Seven had Stargardt disease, 1 bull’s eye maculopathy, 5 age-related macular degeneration, 1 Best disease, and 1 pattern dystrophy. All tested eyes had areas of abnormal fundus autofluorescence. The PRL was evaluated with fundus photography and the Nidek microperimeter. Visual field sensitivity was measured with the Nidek microperimeter. Results Of the 15 eyes, 4 had foveal and 11 had eccentric fixation. Eccentric PRLs were above the atrophic lesion and their stability did not depend on the degree of eccentricity from the fovea. Visual sensitivity was markedly decreased in locations corresponding to hypofluorescent areas. Sensitivity was not decreased in hyperfluorescent areas corresponding to flecks but was decreased if hyperfluorescence was in the form of dense annuli. Conclusion Eccentric PRLs were in the superior retina in regions of normal fundus autofluorescence. Fixation stability was not correlated with the degree of eccentricity from the fovea. To assess the outcomes of treatment trials it is important to use methods that relate retinal morphology to visual function. PMID:18628727

  4. Management of pseudophakic cystoid macular edema.

    PubMed

    Guo, Suqin; Patel, Shriji; Baumrind, Ben; Johnson, Keegan; Levinsohn, Daniel; Marcus, Edward; Tannen, Brad; Roy, Monique; Bhagat, Neelakshi; Zarbin, Marco

    2015-01-01

    Pseudophakic cystoid macular edema (PCME) is a common complication following cataract surgery. Acute PCME may resolve spontaneously, but some patients will develop chronic macular edema that affects vision and is difficult to treat. This disease was described more than 50 years ago, and there are multiple options for clinical management. We discuss mechanisms, clinical efficacy, and adverse effects of these treatment modalities. Topical non-steroidal anti-inflammatory agents and corticosteroids are widely used and, when combined, may have a synergistic effect. Intravitreal corticosteroids and anti-vascular endothelial growth factor (anti-VEGF) agents have shown promise when topical medications either fail or have had limited effects. Randomized clinical studies evaluating anti-VEGF agents are needed to fully evaluate benefits and risks. When PCME is either refractory to medical therapy or is associated with significant vitreous involvement, pars plana vitrectomy has been shown to improve outcomes, though it is associated with additional risks. Copyright © 2015 Elsevier Inc. All rights reserved.

  5. Macular hole closure following spontaneous release of vitreomacular traction.

    PubMed

    Ozgonul, Cem; Besirli, Cagri G

    2017-03-01

    We describe the temporal changes observed with spectral-domain optical coherence tomography (SD-OCT) in the left eye of a 65-year-old man who developed a stage 1 macular hole secondary to vitreomacular traction (VMT). After 1 month, VMT had resolved spontaneously with a complete posterior vitreous detachment. Following VMT resolution, macular hole demonstrated progressive improvement and outer retinal disruption recovered spontaneously. This report highlights the importance of observation before any intervention for cases of stage 1 macular hole associated with VMT.

  6. [Current concepts in pathogenesis of age-related macular degeneration].

    PubMed

    Kubicka-Trząska, Agnieszka; Karska-Basta, Izabella; Romanowska-Dixon, Bożena

    2014-01-01

    Age-related macular degeneration is the leading cause of central blindness in elderly population of the western world. The pathogenesis of this disease, likely multifactorial, is not well known, although a number of theories have been put forward, including oxidative stress, genetic interactions, hemodynamic imbalance, immune and inflammatory processes. The understanding of age-related macular degeneration pathogenesis will give rise to new approaches in prevention and treatment of the early and late stages of both atrophic and neovascular age-related macular degeneration.

  7. [Physiopathology of macular edema in central vein occlusion].

    PubMed

    Stanca, Horia T; Manea, Georgiana

    2012-01-01

    Retinal Vein Occlusions are vascular diseases affecting the Central Retinal Vein and its branches causing decreased retinal drainage resulting in significant clinical and functional pathological changes. RVO determines the increase of vascular permeability, with edema and hemorrhage and development of collateral vessels in a few weeks. Among the serious consequences of venous occlusion is the installation of macular edema to which depends long-term visual prognosis. Macular Edema is the accumulation of intraretinal serous fluid in the macular area caused by the breakdown of blood-retinal barrier.

  8. Guns and states: pediatric firearm injury.

    PubMed

    Lee, Justin; Moriarty, Kevin P; Tashjian, David B; Patterson, Lisa A

    2013-07-01

    A recent report indicates that firearm-related injuries are responsible for 30% of pediatric trauma fatality. The literature is however limited in examining pediatric firearm injuries and variations in state gun control laws. Therefore, we sought to examine the association between pediatric firearm injuries and the Stand-Your-Ground (SYG) and Child Access Protection (CAP) laws. All pediatric (age, 0-20 years) hospitalizations with firearm injuries were identified from the Kids' Inpatient Database from 2006 and 2009. States were compared for SYG and CAP laws. A total of 19,233 firearm injury hospitalizations were identified, with 64.7% assault, 27.2% accidental, and 3.1% suicide injury. Demographics for assault injury were as follows: mean age of 17.6 years, 88.4% male, 44.4% black, 18.2% Hispanic, 70.5% from metropolitan areas, and 50.1% from the poorest median income neighborhoods. Suicide injury cases were more likely to be white (57.8% vs. 16.6%, p < 0.001) and female (15.1% vs. 9.8%, p < 0.001). States with the SYG law were associated with increased accidental injury (odds ratio [OR], 1.282; p < 0.001). There was no statistical association between CAP law and the incidence of accidental injury or suicide. Multivariate logistic regression analysis found other predictive demographic factors for firearm injury: black (OR, 6.164), urban areas (OR, 1.557), poorest median income neighborhoods (OR, 2.785), male (OR, 28.602), and 16 years or older (OR, 37.308). Total economic burden was estimated at more than $1 billion dollars, with a median length of stay of 3 days, 8.4% discharge to rehabilitation, and 6.2% in-hospital mortality. Pediatric firearm injuries continue to be a significant source of morbidity, mortality, and economic burden. A significant increase in accidental firearm injuries in states with the SYG law may highlight inadvertent effects of the law. Race, sex, and median income are additional contributing factors. Advocacy and focused educational efforts

  9. Epidemiology of Injuries in Belgium: Contribution of Hospital Data for Surveillance

    PubMed Central

    Levêque, Alain; Di Pierdomenico, Lionel; Dramaix-Wilmet, Michèle; Pirson, Magali

    2014-01-01

    Objectives. Investigating injuries in terms of occurrences and patient and hospital stay characteristics. Methods. 17370 stays, with at least one E code, were investigated based on data from 13 Belgian hospitals. Pearson's chi-square and Kruskal-Wallis tests were used to assess the variations between distributions of the investigated factors according to the injury's types. Results. Major injuries were accidental falls, transport injuries, and self-inflicted injuries. There were more men in the transport injuries group and the accidental falls group was older. For the transport injuries, there were more arrivals with the support of a mobile intensive care unit and/or a paramedic intervention team and a general practitioner was more implicated for the accidental falls. In three-quarters of cases, it was a primary diagnostic related to injury and poisoning which was made. The median length of stay was nearly equal to one week and for accidental falls, this value is three times higher. The median cost, from the social security point of view, for all injuries was equal to €1377 and there was a higher median cost within the falls group. Conclusion. This study based on hospitals data provides important information both on factors associated with and on hospital costs generated by injuries. PMID:24877072

  10. Rebound of macular edema after intravitreal bevacizumab therapy in eyes with macular edema secondary to branch retinal vein occlusion.

    PubMed

    Yasuda, Shunsuke; Kondo, Mineo; Kachi, Shu; Ito, Yasuki; Terui, Takayuki; Ueno, Shinji; Terasaki, Hiroko

    2011-06-01

    To determine the incidence of rebound macular edema after intravitreal bevacizumab in eyes with macular edema secondary to branch retinal vein occlusion and to identify the pretreatment factors that were significantly associated with the rebound. The changes in the foveal thickness after the intravitreal bevacizumab (1.25 mg/0.05 mL) were studied in 65 eyes of 65 patients with macular edema secondary to branch retinal vein occlusion. A rebound of macular edema was defined as a ≥110% increase in the foveal thickness or a foveal thickness ratio of ≥110% (foveal thickness at the recurrence/foveal thickness at the baseline × 100). Multivariate logistic regression analyses and subgroup analyses were performed to determine which pretreatment factors were associated with the rebound. Seven of 65 eyes (10.8%) showed a rebound (≥110% of baseline thickness). Subgroup analyses showed that a thinner pretreatment fovea and a shorter interval between symptom onset to the initiation of the intravitreal bevacizumab were significantly associated with a rebound of macular edema (P < 0.01). The interval from symptoms onset to the initiation of treatment was <8 weeks in all 7 eyes with a rebound macular edema. These results suggest that a rebound of macular edema in eyes with branch retinal vein occlusion was more likely to occur when the intravitreal bevacizumab therapy is initiated before the macular edema reaches the maximum level. Rebound of macular edema may be effectively avoided by waiting at least 8 weeks after the onset of symptoms to begin the intravitreal bevacizumab.

  11. Anti-vascular endothelial growth factor therapy for diabetic macular edema

    PubMed Central

    Hopkins, J. Jill; Sorof, Jonathan; Ehrlich, Jason S.

    2013-01-01

    Diabetes mellitus is a serious health problem that affects over 350 million individuals worldwide. Diabetic retinopathy (DR), which is the most common microvascular complication of diabetes, is the leading cause of new cases of blindness in working-aged adults. Diabetic macular edema (DME) is an advanced, vision-limiting complication of DR that affects nearly 30% of patients who have had diabetes for at least 20 years and is responsible for much of the vision loss due to DR. The historic standard of care for DME has been macular laser photocoagulation, which has been shown to stabilize vision and reduce the rate of further vision loss by 50%; however, macular laser leads to significant vision recovery in only 15% of treated patients. Mechanisms contributing to the microvascular damage in DR and DME include the direct toxic effects of hyperglycemia, sustained alterations in cell signaling pathways, and chronic microvascular inflammation with leukocyte-mediated injury. Chronic retinal microvascular damage results in elevation of intraocular levels of vascular endothelial growth factor A (VEGF), a potent, diffusible, endothelial-specific mitogen that mediates many important physiologic processes, including but not limited to the development and permeability of the vasculature. The identification of VEGF as an important pathophysiologic mediator of DME suggested that anti-VEGF therapy delivered to the eye might lead to improved visual outcomes in this disease. To date, four different inhibitors of VEGF, each administered by intraocular injection, have been tested in prospective, randomized phase II or phase III clinical trials in patients with DME. The results from these trials demonstrate that treatment with anti-VEGF agents results in substantially improved visual and anatomic outcomes compared with laser photocoagulation, and avoid the ocular side effects associated with laser treatment. Thus, anti-VEGF therapy has become the preferred treatment option for the

  12. Parental substance abuse and accidental death in children.

    PubMed

    Palmiere, Cristian; Staub, Christian; La Harpe, Romano; Mangin, Patrice

    2010-05-01

    In this report, the authors present two cases of accidental death in children of addicted parents. In the first case, the child was left unattended at home while the mother went out to buy cocaine. She was arrested and detained with no mention of the unsupervised child. The cause of death in this case was determined to be starvation and dehydration. In the second case, a child mistakenly received a methadone suppository by her father instead of an antipyretic suppository. Toxicological analysis of the femoral blood revealed methadone at a concentration of 1.2 mg/L. The cause of death was determined to be methadone intoxication. The literature is reviewed and discussed. We report these cases to illustrate the risk of harm to children from illicit drugs and prescription medications at home and because there is no mention of accidental death in children following a methadone suppository administration in the current literature.

  13. Food allergy: practical approach on education and accidental exposure prevention.

    PubMed

    Pádua, I; Moreira, A; Moreira, P; Barros, R

    2016-09-01

    Food allergies are a growing problem and currently the primary treatment of food allergy is avoidance of culprit foods. However, given the lack of information and education and also the ubiquitous nature of allergens, accidental exposures to food allergens are not uncommon. The fear of potential fatal reactions and the need of a proper avoidance leads in most of the cases to the limitation of leisure and social activities. This review aims to be a practical approach on education and accidental exposure prevention regarding activities like shopping, eating out, and travelling. The recommendations are focused especially on proper reading of food labels and the management of the disease, namely in restaurants and airplanes, concerning cross-contact and communication with other stakeholders. The implementation of effective tools is essential to manage food allergy outside home, avoid serious allergic reactions and minimize the disease's impact on individuals' quality of life.

  14. Epidemiology of accidental drowning in Denmark 1989-1993.

    PubMed

    Steensberg, J

    1998-11-01

    Three hundred and forty-nine cases of accidental drowning or cooling in water occurring in Denmark from 1989 to 1993 have been studied. The incidence was highest in 0-4-year-old children, in middle-aged men, and in old people. A third of the children drowned in private pools. A quarter of all fatalities occurred during leisure boating. At least half of those that drowned in this way did not wear a life-jacket and could have been saved if they had been wearing one. Between a third and a half of the adult drownings were related to alcohol intake, and a large number of inebriated men fell into harbour basins and other water bodies. A few final remarks are made on the prospects for preventing accidental drowning in children, elderly people and adult males.

  15. Accidental ingestion of a fractured Twin-block appliance.

    PubMed

    Rohida, Neeraj S; Bhad, Wasundhara A

    2011-01-01

    Orthodontic appliances that become dislodged can cause problems in the airway or the gastrointestinal tract. Accidental ingestion of an appliance during a chair-side procedure or because of inadequate retention of the appliance can create a medical emergency with potentially serious complications, including death from aspiration of the foreign body. This article reports the accidental ingestion of a fractured Twin-block appliance. The ease with which removable appliances can become dislodged if retention is inadequate is discussed, and some serious complications that can arise are described. Precautions the orthodontist can take to prevent such accidents are presented. Copyright © 2011 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.

  16. Accidental mydriasis from exposure to Angel's trumpet (Datura suaveolens).

    PubMed

    Havelius, Ulf; Asman, Peter

    2002-06-01

    To report clinical findings after accidental instillation into the eye of sap from Angel's trumpet (Datura suaveolens). We report findings on seven patients who developed sudden onset of unilateral mydriasis. At least three of them also had ipsilateral cycloplegia and one developed transient tachycardia. The symptoms evolved after ocular exposure to sap from Angel's trumpet, a plant containing natural alkaloids with parasympatholytic properties. Six patients were initially unaware of the cause of their symptoms. In these cases, patient history revealed recent contact with Angel's trumpet. Accidental ocular instillation of sap from Angel's trumpet should be noted as a cause of sudden onset of mydriasis in otherwise unaffected patients and also of general symptoms like tachycardia.

  17. Accidentally discovered large metallic intra-orbital foreign body.

    PubMed

    Adamu, Yilikal

    2002-01-01

    A 6.2 cm long and 2.7 cm thick metallic foreign body was accidentally found and removed from a 62 years old man. He was sent to a minor operation theater for repair of left lower lid laceration secondary to trauma after a fight. Subsequent investigation, management, patient follow-up and outcome are discussed. Importance of careful history taking, thorough physical examination and proper investigations are stressed.

  18. Strangulation injury from indigenous rocking cradle

    PubMed Central

    Saha, Abhijeet; Batra, Prerna; Bansal, Anuradha

    2010-01-01

    Indigenously made rocking cradle is frequently used in rural India. We report strangulation from an indigenously made rocking cradle in an 11-month-old female child. The unique mode of injury and its mechanism have been discussed. Strangulation is an important cause of homicidal and suicidal injury in adults but in children it is usually accidental leading to death due to asphyxia as a result of partial hanging. In western countries, it is the third most common cause of accidental childhood deaths, 17% of them being due to ropes and cords. It ranks fourth amongst the causes of unintentional injury in children less than 1 year of age following roadside accidents, drowning and burns. However, in India, strangulation injury is under reported although indigenous rocking cradles are very commonly used in rural India, and they are even more dangerous than the cribs and adult beds as there are no safety mechanisms therein. We report a case of accidental strangulation following suspension from an indigenously made rocking cradle. The unique mode of injury has prompted us to report this case. PMID:20930979

  19. Strangulation injury from indigenous rocking cradle.

    PubMed

    Saha, Abhijeet; Batra, Prerna; Bansal, Anuradha

    2010-07-01

    Indigenously made rocking cradle is frequently used in rural India. We report strangulation from an indigenously made rocking cradle in an 11-month-old female child. The unique mode of injury and its mechanism have been discussed. Strangulation is an important cause of homicidal and suicidal injury in adults but in children it is usually accidental leading to death due to asphyxia as a result of partial hanging. In western countries, it is the third most common cause of accidental childhood deaths, 17% of them being due to ropes and cords. It ranks fourth amongst the causes of unintentional injury in children less than 1 year of age following roadside accidents, drowning and burns. However, in India, strangulation injury is under reported although indigenous rocking cradles are very commonly used in rural India, and they are even more dangerous than the cribs and adult beds as there are no safety mechanisms therein. We report a case of accidental strangulation following suspension from an indigenously made rocking cradle. The unique mode of injury has prompted us to report this case.

  20. An investigation of accidental ingestion during dental procedures.

    PubMed

    Obinata, Kenichi; Satoh, Takafumi; Towfik, Alam Mohammad; Nakamura, Motoyasu

    2011-12-01

    Twenty-three cases of accidental ingestion during dental procedures, which occurred at the Center for Dental Clinics of Hokkaido University Hospital between 2006 and 2010, were analyzed retrospectively. We examined not only the objects ingested, but also details of the circumstances (treated teeth, types of treatment, professional experience of the practitioners). Except for two cases (an unidentified endodontic file and the tip of an ultrasonic scaler, which were recovered by vacuuming), the other 21 accidentally ingested objects were all found in the digestive tract, and none in the respiratory tract, by radiographic examination of the chest and abdomen. The ingested objects were mostly metal restorations (inlays or onlays) or prostheses (crowns or cores). Ingestion occurred more frequently during treatment of lower molars, and when procedures were being conducted by practitioners with less than 5 years of experience. No adverse events related to ingestion were reported. The present study found no cases of aspiration or complications related to the ingested objects. However, considering the risk of life-threatening emergencies related to accidental aspiration and ingestion, dentists must take meticulous precautions and be ready to deal with this kind of emergency during dental procedures.

  1. Accidental catheterization of epidural venous plexus: tomographic analysis.

    PubMed

    Souza, Mariano Paiva; Magalhães, Edno; de Farias Cascudo, Elialba; Jogaib, Marco Antonio Dias; da Silva, Marcelo Carneiro

    2016-01-01

    Inadvertent venous catheterizations occur in approximately 9% of lumbar epidural anesthetic procedures with catheter placement and, if not promptly recognized, can result in fatal consequences. The objective of this report is to describe a case of accidental catheterization of epidural venous plexus and its recording by computed tomography with contrast injection through the catheter. A female patient in her sixties, physical status II (ASA), underwent conventional cholecystectomy under balanced general anesthesia and an epidural with catheter for postoperative analgesia. During surgery, there was clinical suspicion of accidental catheterization of epidural venous plexus because of blood backflow through the catheter, confirmed by the administration of a test dose through the catheter. After the surgery, a CT scan was obtained after contrast injection through the catheter. Contrast was observed all the way from the skin to the azygos vein, passing through anterior and posterior epidural venous plexuses and intervertebral vein. It is possible to identify the actual placement of the epidural catheter, as well as to register an accidental catheterization of the epidural venous plexus, using computed tomography with contrast injection through the epidural catheter. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  2. [Accidental catheterization of epidural venous plexus: tomographic analysis].

    PubMed

    Souza, Mariano Paiva; Magalhães, Edno; Cascudo, Elialba de Farias; Jogaib, Marco Antonio Dias; Silva, Marcelo Carneiro da

    2016-01-01

    Inadvertent venous catheterizations occur in approximately 9% of lumbar epidural anesthetic procedures with catheter placement and, if not promptly recognized, can result in fatal consequences. The objective of this report is to describe a case of accidental catheterization of epidural venous plexus and its recording by computed tomography with contrast injection through the catheter. A female patient in her sixties, physical status II (ASA), underwent conventional cholecystectomy under balanced general anesthesia and an epidural with catheter for postoperative analgesia. During surgery, there was clinical suspicion of accidental catheterization of epidural venous plexus because of blood backflow through the catheter, confirmed by the administration of a test dose through the catheter. After the surgery, a CT scan was obtained after contrast injection through the catheter. Contrast was observed all the way from the skin to the azygos vein, passing through anterior and posterior epidural venous plexuses and intervertebral vein. It is possible to identify the actual placement of the epidural catheter, as well as to register an accidental catheterization of the epidural venous plexus, using computed tomography with contrast injection through the epidural catheter. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  3. Accidental ingestions of oral prescription drugs: a multicenter survey.

    PubMed Central

    Jacobson, B J; Rock, A R; Cohn, M S; Litovitz, T

    1989-01-01

    Accidental ingestion of oral prescription drugs by children under age five continues to be a public health problem. A telephone survey of 1,866 ingestion incidents reported to nine poison control centers was conducted in the spring of 1986. Accidental ingestion occurred most often with a two-year-old child (42 per cent) in their own home (82 per cent). Thirty-five per cent of the toxic drugs ingested at home belonged to someone other than the immediate family, most often a grandparent. Toxic drugs were more often out of their usual storage location and in non-child-resistant prescription packaging, a nonprescription container, or in no container. Twenty-two per cent of all child-resistant packages were non-functional. Overall, at least 61 per cent of all medications had no child-resistant barrier at the time of ingestion. Accessible storage locations such as the kitchen counter, table top, or top of a dresser or bedside table greatly increased the risk of accidental ingestion. These results suggest the need for effective child-resistant packaging that is easier for all adults to use. PMID:2660604

  4. Prevention of accidental exposure in radiotherapy: the risk matrix approach.

    PubMed

    Vilaragut, J J; Duménigo, C; Delgado, J M; Morales, J; McDonnell, J D; Ferro, R; Ortiz López, P; Ramírez, M L; Pérez Mulas, A; Papadopulos, S; Gonçalves, M; López Morones, R; Sánchez Cayuela, C; Cascajo Castresana, A; Somoano, F; Álvarez, C; Guillén, A; Rodríguez, M; Pereira, P P; Nader, A

    2013-02-01

    Knowledge and lessons from past accidental exposures in radiotherapy are very helpful in finding safety provisions to prevent recurrence. Disseminating lessons is necessary but not sufficient. There may be additional latent risks for other accidental exposures, which have not been reported or have not occurred, but are possible and may occur in the future if not identified, analyzed, and prevented by safety provisions. Proactive methods are available for anticipating and quantifying risk from potential event sequences. In this work, proactive methods, successfully used in industry, have been adapted and used in radiotherapy. Risk matrix is a tool that can be used in individual hospitals to classify event sequences in levels of risk. As with any anticipative method, the risk matrix involves a systematic search for potential risks; that is, any situation that can cause an accidental exposure. The method contributes new insights: The application of the risk matrix approach has identified that another group of less catastrophic but still severe single-patient events may have a higher probability, resulting in higher risk. The use of the risk matrix approach for safety assessment in individual hospitals would provide an opportunity for self-evaluation and managing the safety measures that are most suitable to the hospital's own conditions.

  5. An alternative approach for computing seismic response with accidental eccentricity

    NASA Astrophysics Data System (ADS)

    Fan, Xuanhua; Yin, Jiacong; Sun, Shuli; Chen, Pu

    2014-09-01

    Accidental eccentricity is a non-standard assumption for seismic design of tall buildings. Taking it into consideration requires reanalysis of seismic resistance, which requires either time consuming computation of natural vibration of eccentric structures or finding a static displacement solution by applying an approximated equivalent torsional moment for each eccentric case. This study proposes an alternative modal response spectrum analysis (MRSA) approach to calculate seismic responses with accidental eccentricity. The proposed approach, called the Rayleigh Ritz Projection-MRSA (RRP-MRSA), is developed based on MRSA and two strategies: (a) a RRP method to obtain a fast calculation of approximate modes of eccentric structures; and (b) an approach to assemble mass matrices of eccentric structures. The efficiency of RRP-MRSA is tested via engineering examples and compared with the standard MRSA (ST-MRSA) and one approximate method, i.e., the equivalent torsional moment hybrid MRSA (ETM-MRSA). Numerical results show that RRP-MRSA not only achieves almost the same precision as ST-MRSA, and is much better than ETM-MRSA, but is also more economical. Thus, RRP-MRSA can be in place of current accidental eccentricity computations in seismic design.

  6. Accidental falls involving medical implant re-operation.

    PubMed

    Ong, Kevin L; Lau, Edmund; Moore, Tara; Heller, Michelle F

    2009-10-01

    Implantation of medical devices is becoming more prevalent, and as a result, a greater number of patients who fall accidentally are expected to have a medical implant. The Nationwide Inpatient Sample (NIS) was used to evaluate hospital admissions following accidental falls involving re-operation of existing medical implants (hip, knee, spine, and fracture fixation) from 1990 to 2005. From 1990 to 2005, hospitalisations due to accidental falls on level surfaces increased by 306%, and hospitalisations due to falls from stairs increased by 310%. Falls involving orthopaedic revision surgery (re-operation) are relatively rare, but the incidence has increased by approximately 35%. Hospital stays after falls on level surfaces involving re-operation were 1.0 day (median) longer and cost 50% (median) more than those that did not involve re-operation in 2005. After staircase falls, hospital stays for patients undergoing re-operations were 2.0 days (median) longer and cost 108% (median) more. The greater hospital costs and hospital stay for patients needing re-operations indicate that additional medical treatment was required.

  7. A New Sutureless Illuminated Macular Buckle Designed for Myopic Macular Hole Retinal Detachment

    PubMed Central

    Bedda, Ahmed M.; Lolah, Mohamed; Abd Al Shafy, Muhammad S.

    2017-01-01

    Purpose. To report the anatomic and visual results of a new sutureless illuminated macular buckle designed for patients with macular hole retinal detachment related to high myopia (MMHRD). Design. Prospective nonrandomized comparative interventional trial. Methods. Twenty myopic eyes of 20 patients (mean age, 51.4 years; range, 35–65 years) presenting with MMHRD with a posterior staphyloma, in whom the new buckle was used, were evaluated. The buckle used was assembled from a 5 mm wide sponge and a 7 mm wide silicone tire; it was fixed utilizing the sterile topical adhesive Histoacryl Blue (B Braun, TS1050044FP) which polymerizes in seconds upon being exposed to water-containing substances. The primary outcomes measured included aided visual acuity (BCVA) and optical coherence tomography (OCT) findings. The mean follow-up period was 6 months. Results. Postoperatively, the MH closure was identified by OCT in 8 (40%) eyes. The mean BCVA increased from 0.11 to 0.21 (p < 0.005). The axial length of the eyes included decreased from 30.5 mm preoperatively to 29.8 mm (p = 0.002) postoperatively. Conclusion. Preparation of the new sutureless macular buckle is simple and easy. Illumination of the terminal part of the buckle ensures proper placement. Histoacryl Blue is effective in fixing the buckle in its place for at least 6 months with no reported intra- or postoperative complications. PMID:28409023

  8. Acute accidental exposure to chlorine gas: clinical presentation, pulmonary functions and outcomes.

    PubMed

    Mohan, Alladi; Kumar, S Naveen; Rao, M H; Bollineni, S; Manohar, I Chiranjeevi

    2010-01-01

    To study the clinical presentation, pulmonary functions and outcomes in subjects who were accidentally exposed to chlorine gas. Prospective observational study of 64 patients who sustained acute accidental exposure to chlorine gas during a leak in the chlorination system of the public bathing pool of a temple. The major presenting symptoms and signs included acute dyspnoea (100%), chest discomfort (100%), cough (97%), eye irritation (88%), giddiness (72%), vomiting (46%), and heaviness in the head (44%); tachycardia (100%), tachypnoea (96%) and polyphonic wheezing (28%). All patients were managed in the emergency room with humidified oxygen inhalation and beta-2 agonist nebulisation and 52 were discharged within six hours. Twelve patients were severely affected and required hospitalisation; three of them were admitted into the intensive care unit. Three patients developed pulmonary oedema six to eight hours following admission. Pulmonary function testing (n = 12) at presentation revealed obstructive defect in eight and mixed obstructive-cum-restrictive defect in four patients. The mean duration of hospital stay was 5.1 +/- 2.1 days. None of the patients died. Reactive airway dysfunction syndrome (RADS) was observed in three of the 12 hospitalised patients, who complained of manifested persistent cough that lasted for three months period following discharge. Serial pulmonary functions recovered to normal range by the end of the six months in all patients and remained so at one-year follow-up. Acute exposure to chlorine gas is an uncommon, but important public health hazard and can cause RADS, acute lung injury and pulmonary function abnormalities, which are reversible on prompt and appropriate management.

  9. Successful treatment of pseudophakic cystoid macular edema with intravitreal bevacizumab.

    PubMed

    Barone, Antonio; Prascina, Francesco; Russo, Vincenzo; Iaculli, Cristiana; Primavera, Vito; Querques, Giuseppe; Stella, Andrea; Delle Noci, Nicola

    2008-07-01

    A 67-year-old woman developed refractory pseudophakic cystoid macular edema (CME) after uneventful phacoemulsification. Three months after an intravitreal injection of bevacizumab (1.25 mg), the CME was completely resolved, with resultant improvement in visual acuity.

  10. Chronic cystoid macular oedema treated with intravitreal dobesilate

    PubMed Central

    Cuevas, Pedro; Outeiriño, Luis A; Angulo, Javier; Giménez-Gallego, Guillermo

    2012-01-01

    Dobesilate is an anti-inflammatory and antipermeability agent. Intravitreal administration of this compound is a therapeutically beneficial agent in the treatment of chronic cystoid macular oedema. PMID:22778475

  11. Typical Skin Injuries in Children With Autism Spectrum Disorder.

    PubMed

    Slingsby, Brett; Yatchmink, Yvette; Goldberg, Amy

    2017-09-01

    Pediatric skin injuries have primarily been described in typically developing children. Our objectives were to describe the prevalence and pattern of skin injuries of children with autism spectrum disorder (ASD), to describe how this compared with previously demonstrated skin injury locations in typically developing children, and to identify differences in skin injury frequency and locations between autistic children with and without self-injurious behaviors (SIBs). Children with ASD were recruited between September of 2011 and September of 2014. Demographic information was obtained from the caregiver. All skin injuries and their locations were documented. Of the 41 children enrolled, half were reported to have SIBs. The most identified skin injury locations were the legs, knees, and back. Children with autism (1) obtain skin injuries frequently and in similar locations as typically developing children and (2) rarely obtain skin injuries to locations that are considered uncommon for accidental injuries despite reports of SIBs.

  12. Multiple extra macular branch retinal vein occlusions in hyperhomocysteinemia

    PubMed Central

    Gore, Abhijit Diwakar; Rao, Girish Shiva; Gore, Mansi Abhijit; Desai, Abhishek R

    2014-01-01

    Hyperhomocysteinemia is a well-known modifiable risk factor for thromboembolism. Retinal vascular occlusion in patients having hyperhomocysteinemia is a known entity, particularly in young patients. However, multiple extra macular branch retinal vein occlusion (BRVO) is a rare condition, which can be a presentation of this disease. We present a patient who had multiple extra macular BRVO; on complete systemic workup, he was found to have raised homocysteine levels. PMID:24817751

  13. [Spontaneous closure of full thickness traumatic macular holes].

    PubMed

    Bosch-Valero, J; Mateo, J; Lavilla-García, L; Núñez-Benito, E; Cristóbal, J A

    2008-05-01

    We present case reports of two young patients suffering from full thickness traumatic macular holes resulting in visual impairment of more than 60%. Both showed anatomical and visual improvement whilst waiting for surgical treatment. Spontaneous closure of a traumatic macular hole is an unusual outcome. OCT and clinical follow up enabled monitoring of this resolution during a period of a few weeks. Complex surgery was thus avoided by a short observational period.

  14. Classification of Full-Thickness Traumatic Macular Holes by Optical Coherence Tomography

    PubMed Central

    Huang, Jingjing; Liu, Xing; Wu, Ziqiang; Lin, Xiaofeng; Li, Mei; Dustin, Laurie; Sadda, Srinivas

    2009-01-01

    Purpose To describe morphological features of traumatic macular holes (TMH) on optical coherence tomography (OCT) and to correlate them with clinical findings. Methods Seventy-three consecutive patients diagnosed with full-thickness TMH involving the fovea underwent complete ophthalmic evaluation followed by horizontal and vertical line scans using the StratusOCT. Retinal thickness at the edges of the holes, apical and basal diameters, and various clinical parameters were recorded. The approximate apical and basal areas and eccentricities of the holes were calculated. Morphological parameters were correlated with clinical findings. Results Based on OCT findings, TMHs were classified into 5 morphological types with varying average retinal thicknesses, apical areas, and basal areas. Patients who presented more than 90 days after injury had greater average retinal thickness (p=0.03) and apex areas (p=0.002) compared to those who presented within 90 days. Older patients developed more circular holes, i.e. less eccentricity of the apex (p=0.04) and base (p=0.01). Interestingly, none of the morphological parameters investigated in the current study correlated with visual acuity. Patients who presented later in the clinical course or who had greater average retinal thicknesses tended to have better vision (p=0.11 and p=0.07, respectively). Conclusions OCT evaluation may yield important insights into the pathogenesis and clinical findings of traumatic macular holes. PMID:19092730

  15. Pseudophakic cystoid macular edema: update 2016

    PubMed Central

    Grzybowski, Andrzej; Sikorski, Bartosz L; Ascaso, Francisco J; Huerva, Valentín

    2016-01-01

    Pseudophakic cystoid macular edema (PCME) is the most common complication of cataract surgery, leading in some cases to a decrease in vision. Although the pathogenesis of PCME is not completely understood, the contribution of postsurgical inflammation is generally accepted. Consequently, anti-inflammatory medicines, including steroids and nonsteroidal anti-inflammatory drugs, have been postulated as having a role in both the prophylaxis and treatment of PCME. However, the lack of a uniformly accepted PCME definition, conflicting data on some risk factors, and the scarcity of studies comparing the role of nonsteroidal anti-inflammatory drugs to steroids in PCME prevention make the problem of PCME one of the puzzles of ophthalmology. This paper presents an updated review on the pathogenesis, risk factors, and use of anti-inflammatory drugs in PCME that reflect current research and practice. PMID:27672316

  16. Idiopathic eruptive macular pigmentation with papillomatosis

    PubMed Central

    Verma, Shikha; Thakur, Binod Kumar

    2011-01-01

    We present a case of an otherwise healthy 10-year-old girl who presented with asymptomatic brown macules over the trunk and proximal extremities, of three months’ duration. The cutaneous examination revealed multiple, dark brown, discrete, round to oval macules and a few mildly elevated lesions over the trunk and proximal limbs. The individual lesion was 1-3 cm in diameter and a few showed velvety appearance over the surface. Darier's sign was negative. The histopathological study from the velvety lesion showed acanthosis, papillomatosis and increased melanin in the basal layer. The upper dermis showed sparse perivascular infiltrate of lymphocytes without any dermal melanophages. It fulfilled the criteria for idiopathic eruptive macular pigmentation with additional histological finding of papillomatosis. PMID:23130237

  17. Update on corticosteroids for diabetic macular edema

    PubMed Central

    Schwartz, Stephen G; Scott, Ingrid U; Stewart, Michael W; Flynn, Harry W

    2016-01-01

    Diabetic macular edema (DME) remains an important cause of visual loss. Although anti-vascular endothelial growth factor (VEGF) agents are generally used as first-line treatments for patients with center-involving DME, there is an important role for corticosteroids as well. Corticosteroids may be especially useful in pseudophakic patients poorly responsive to anti-VEGF therapies, in patients wishing to reduce the number of required injections, and in pregnant patients. Intravitreal triamcinolone acetonide has been used for many years but is not approved for this indication. An extended-release bioerodable dexamethasone delivery system and an extended-release nonbioerodable fluocinolone acetonide insert have both achieved regulatory approval for the treatment of DME. All intravitreal corticosteroids are associated with risks of cataract progression, elevation of intraocular pressure, and endophthalmitis. There is no current consensus regarding the use of corticosteroids, but they are valuable for selected patients with center-involving DME. PMID:27660409

  18. Prevention of age-related macular degeneration

    PubMed Central

    Koo, Simon Chi Yan; Chan, Clement Wai Nang

    2010-01-01

    Age-related macular degeneration (AMD) is one of the leading causes of blindness in the developed world. Although effective treatment modalities such as anti-VEGF treatment have been developed for neovascular AMD, there is still no effective treatment for geographical atrophy, and therefore the most cost-effective management of AMD is to start with prevention. This review looks at current evidence on preventive measures targeted at AMD. Modalities reviewed include (1) nutritional supplements such as the Age-Related Eye Disease Study (AREDS) formula, lutein and zeaxanthin, omega-3 fatty acid, and berry extracts, (2) lifestyle modifications, including smoking and body-mass-index, and (3) filtering sunlight, i.e. sunglasses and blue-blocking intraocular lenses. In summary, the only proven effective preventive measures are stopping smoking and the AREDS formula. PMID:20862519

  19. Macular dazzling test on normal subjects.

    PubMed Central

    Gomez-Ulla, F; Louro, O; Mosquera, M

    1986-01-01

    The macular dazzling test was performed on 240 healthy eyes, classified into six groups according to the ages of the subjects. The test was used to assess both long distance and short distance vision with a simultaneous study of the influence of mydriasis and miosis. The MDT is a test easy to perform, requires a minimum of co-operation by the subject, and gives repeatable results. The MDT values increase significantly as the age of the subject increases. The sex of the subject has no influence on it, and there are no significant differences between a subject's right and left eyes. Mydriasis does not affect the MDT, but miosis reduces the recovery period. All the values are statistically greater for long distance vision than for short distance vision. PMID:3954979

  20. Macular holes associated with diabetic tractional retinal detachments.

    PubMed

    Mason, John O; Somaiya, Mamta D; White, Milton F; Vail, Rachel S

    2008-01-01

    Evaluation of surgical treatment of full-thickness macular holes secondary to diabetic tractional retinal detachments was conducted. A retrospective review of medical records, fluorescein angiograms, fundus photographs, optical coherence tomography images, and operative findings of six consecutive patients with full-thickness macular holes and diabetic tractional retinal detachments was completed. Each eye was treated with pars plana vitrectomy, tractional retinal detachment repair, membranectomy, indocyanine green-assisted internal limiting membrane peeling, and intraocular gas tamponade. Surgical intervention resulted in the closure of all full-thickness macular holes. Mean best-corrected visual acuity was 20/250 preoperatively and 20/100 postoperatively, with all patients having improvement after a mean follow-up of 10 months. Closure of tractional retinal detachments related to full-thickness macular holes can be achieved via pars plana vitrectomy, complete membranectomy, and intraocular gas. Vitrectomy with dissection of proliferative membranes helps to relieve the tractional forces responsible for full-thickness macular hole formation, enabling successful closure of the diabetic full-thickness macular holes and resulting in visual acuity improvement.

  1. Full thickness macular hole case after intravitreal aflibercept treatment.

    PubMed

    Oshima, Yuji; Apte, Rajendra S; Nakao, Shintaro; Yoshida, Shigeo; Ishibashi, Tatsuro

    2015-03-29

    The pathogenesis of macular hole formation is widely accepted as a tractional force at the vitreo-retinal interface in fovea. We report a case of macular hole after intravitreous aflibercept injection for age-related macular degeneration (AMD) associated with contraction of the retinal pigment epithelium (RPE) at the edge of a fibrovascular pigment epithelial detachment (PED). A 94-year old man with neovascular AMD affecting his left eye accompanied by a fibrovascular PED was examined for severe vision loss. Although RPE tear in his left eye was identified before the first aflibercept intravitreous injection performed in order to treat neovascular AMD, he received three aflibercept injections as induction treatment. After induction treatment, a full thickness macular hole was identified associated with the contracted rolled RPE edge beneath the retina. Macular hole is commonly formed associated with tangential vitreous traction. Current report suggests that rapid contraction of the RPE underneath the retina can be one of the causes of a macular hole, and one of the side effects of anti-VEGF therapy for neovascular AMD.

  2. [Macular surgery in a new point of view].

    PubMed

    Branişteanu, D; Moraru, Andreea

    2014-01-01

    To reveal the differences in anatomical and functional results following standard 20-gauge vitrectomy and modern transconjunctival sutureless vitrectomy in macular surface pathology. Retrospective, interventional, comparative evaluation of macular pathology cases operated by standard 20-gauge vitrectomy and transconjunctival 23 G sutureless vitrectomy. In evaluation were included a comparable number of epiretinal membranes (both idiopathic and secondary) and stage 3 and 4 macular holes. A postoperative anatomical and functional analysis was performed and also the incidence of pre-and postoperative complications was noted. Transconjunctival sutureless vitrectomy was associated with a shorter operating time and quicker anatomical and functional results. If in epiretinal membranes there was no significant difference in final results, in macular holes anatomical and functional results were better with sutureless vitrectomy. These results confirm the efficacy and safety of both surgical procedures in macular surface pathology. Better anatomical and functional results in macular holes and quicker functional rehabilitation in all cases promote sutureless vitrectomy as new standard procedure in these cases.

  3. Superglue injuries of the eye

    PubMed Central

    Reddy, Sagili Chandrasekhara

    2012-01-01

    AIM To report various ocular lesions caused by accidental instillation of superglue. METHODS Three cases of ocular injuries are described in children aged 6 years, 3 years and 8 months, following accidental instillation of superglue in the eye. RESULTS In the first case there was sticking of eyelashes in the medial 1/3 of eyelids in both eyes. In the second case sticking of eye lashes was present in the lateral 1/3 of eyelids in the left eye. In the third case, superglue was present on the right cheek, above the right ear and sticking of eyelids in medial 1/3 in right eye. The eyelids were separated by pulling the lid margins with fingers in the first case and later on superglue was removed by trimming the eyelashes; and by direct trimming the eyelashes in second and third cases. There was no injury to other structures of anterior segment in the first two cases. However, removal of the superglue on the cornea resulted in corneal abrasion in the third case which healed with medical treatment and patching of the right eye. CONCLUSION Accidental instillation of superglue is possible because of the appearance of the tube like eye ointment tube. Immediate medical aid will prevent ocular morbidity. PMID:23166877

  4. Confocal laser tomographic analysis of the retina in eyes with macular hole formation and other focal macular diseases.

    PubMed

    Bartsch, D U; Intaglietta, M; Bille, J F; Dreher, A W; Gharib, M; Freeman, W R

    1989-09-15

    To study the retinal surface in the human eye in normal and diseased states we used laser scanning tomography. The confocal arrangement of the laser tomographic scanner permits examination of retinal topography in the axis perpendicular to the retinal surface. The eyes examined with the laser tomographic scanner included normal eyes, eyes with macular holes, impending macular holes, radiation retinopathy, macular edema, photocoagulation scars, subfoveal scars, and serous detachment of the fovea associated with subretinal neovascularization. The laser tomographic scanner is a new method that allows measurements of the topography of the internal limiting membrane in the macular area and may improve our understanding of the pathophysiologic characteristics and treatment of a variety of disorders of the macula.

  5. Diabetic Macular Edema: Options for Adjunct Therapy.

    PubMed

    Calvo, Pilar; Abadia, Beatriz; Ferreras, Antonio; Ruiz-Moreno, Oscar; Verdes, Guayente; Pablo, Luis E

    2015-09-01

    Diabetes mellitus (DM) is a chronic disease that affects 387 million people worldwide. Diabetic retinopathy (DR), a common complication of DM, is the main cause of blindness in the active population. Diabetic macular edema (DME) may occur at any stage of DR, and is characterized by vascular hyperpermeability accompanied by hard exudates within the macula. Medical and surgical therapies have dramatically reduced the progression of DR, and timely intervention can reduce the risk of severe vision loss by more than 90 %. In 2012, intravitreal ranibizumab became the first antivascular endothelial growth factor (anti-VEGF) agent approved for DME and, since then, many reports of the use of ranibizumab for DME have been promising. Randomized, prospective, multicenter clinical trials-most notably, RESOLVE, READ-2, RISE/RIDE, RESTORE, DRCR.net protocol I, and RETAIN-reported improvements in best-corrected visual acuity and decreased central retinal thickness as measured with optical coherence tomography in patients with DME. Similar treatment benefits have also been noted in clinical trials evaluating intravitreal aflibercept and bevacizumab (DAVINCI, VISTA/VIVID, and BOLT) and more recently DRCR.net protocol T. Intravitreal steroids (dexamethasone intravitreal implant and fluocinolone acetonide), particularly in refractory cases, also play a significant role in the management of DME (MEAD/CHAMPLAIN and FAMOUS/FAME studies). In summary, over the last 5 years, blocking VEGF and inflammation has been shown to improve visual outcomes in patients with macular edema due to DM, revolutionizing the treatment of center-involved DME and establishing a new standard of care.

  6. Macular thickness in healthy Saudi adults

    PubMed Central

    Al-Zamil, Waseem M.; Al-Zwaidi, Fahad M.; Yassin, Sanaa A.

    2017-01-01

    Objectives: To determine the macular thickness in the eyes of healthy Saudi adults using spectral-domain optical coherence tomography (SD-OCT). Methods: This is a prospective, cross-sectional study, including 158 healthy participants between August and December 2015. Mean subject age was 29.9 ± 7.85 years old. All participants underwent full ophthalmic evaluation, including SD-OCT imaging, and axial length measurement. Data from the right eye were included. Mean retinal thickness was determined. Correlations between retinal thickness and gender, age, axial length, and spherical equivalence were analyzed. Results: Mean central retinal thickness was 244.76 ± 23.62 µm, mean axial length was 23.8 ± 1.062 mm (range: 20.5-29 mm) and mean spherical equivalent was -0.31 ± 1.75 diopters (D) (range: -5.50 to +4.25 D). Central subfield (CSF) thickness and foveal volume were significantly lower in women than in men (both p<0.001). Data from the various age groups did not show statistically significant differences in the CSF thickness (p=0.389) or foveal volume (p=0.341). A positive correlation between CSF thickness and axial length (p<0.001) was observed. Conclusion: The normal macular thickness values in healthy Saudi individuals is different from that reported in other ethnic groups, as obtained by SD-OCT. Saudi men had thicker CSF than Saudi women and axial length was positively correlated to the central foveal thickness. PMID:28042632

  7. Perceptual learning in patients with macular degeneration.

    PubMed

    Plank, Tina; Rosengarth, Katharina; Schmalhofer, Carolin; Goldhacker, Markus; Brandl-Rühle, Sabine; Greenlee, Mark W

    2014-01-01

    Patients with age-related macular degeneration (AMD) or hereditary macular dystrophies (JMD) rely on an efficient use of their peripheral visual field. We trained eight AMD and five JMD patients to perform a texture-discrimination task (TDT) at their preferred retinal locus (PRL) used for fixation. Six training sessions of approximately one hour duration were conducted over a period of approximately 3 weeks. Before, during and after training twelve patients and twelve age-matched controls (the data from two controls had to be discarded later) took part in three functional magnetic resonance imaging (fMRI) sessions to assess training-related changes in the BOLD response in early visual cortex. Patients benefited from the training measurements as indexed by significant decrease (p = 0.001) in the stimulus onset asynchrony (SOA) between the presentation of the texture target on background and the visual mask, and in a significant location specific effect of the PRL with respect to hit rate (p = 0.014). The following trends were observed: (i) improvement in Vernier acuity for an eccentric line-bisection task; (ii) positive correlation between the development of BOLD signals in early visual cortex and initial fixation stability (r = 0.531); (iii) positive correlation between the increase in task performance and initial fixation stability (r = 0.730). The first two trends were non-significant, whereas the third trend was significant at p = 0.014, Bonferroni corrected. Consequently, our exploratory study suggests that training on the TDT can enhance eccentric vision in patients with central vision loss. This enhancement is accompanied by a modest alteration in the BOLD response in early visual cortex.

  8. Perceptual learning in patients with macular degeneration

    PubMed Central

    Plank, Tina; Rosengarth, Katharina; Schmalhofer, Carolin; Goldhacker, Markus; Brandl-Rühle, Sabine; Greenlee, Mark W.

    2014-01-01

    Patients with age-related macular degeneration (AMD) or hereditary macular dystrophies (JMD) rely on an efficient use of their peripheral visual field. We trained eight AMD and five JMD patients to perform a texture-discrimination task (TDT) at their preferred retinal locus (PRL) used for fixation. Six training sessions of approximately one hour duration were conducted over a period of approximately 3 weeks. Before, during and after training twelve patients and twelve age-matched controls (the data from two controls had to be discarded later) took part in three functional magnetic resonance imaging (fMRI) sessions to assess training-related changes in the BOLD response in early visual cortex. Patients benefited from the training measurements as indexed by significant decrease (p = 0.001) in the stimulus onset asynchrony (SOA) between the presentation of the texture target on background and the visual mask, and in a significant location specific effect of the PRL with respect to hit rate (p = 0.014). The following trends were observed: (i) improvement in Vernier acuity for an eccentric line-bisection task; (ii) positive correlation between the development of BOLD signals in early visual cortex and initial fixation stability (r = 0.531); (iii) positive correlation between the increase in task performance and initial fixation stability (r = 0.730). The first two trends were non-significant, whereas the third trend was significant at p = 0.014, Bonferroni corrected. Consequently, our exploratory study suggests that training on the TDT can enhance eccentric vision in patients with central vision loss. This enhancement is accompanied by a modest alteration in the BOLD response in early visual cortex. PMID:25368597

  9. The Association Between Subretinal Drusenoid Deposits in Older Adults in Normal Macular Health and Incident Age-Related Macular Degeneration.

    PubMed

    Huisingh, Carrie; McGwin, Gerald; Neely, David; Zarubina, Anna; Clark, Mark; Zhang, Yuhua; Curcio, Christine A; Owsley, Cynthia

    2016-02-01

    Subretinal drusenoid deposits (SDD) have been associated with the progression to late age-related macular degeneration (AMD). To determine whether SDD in eyes in normal macular health increases risk for early AMD, this study examined the association between presence of SDD at baseline in a cohort of older adults in normal macular health and incident AMD 3 years later. Subjects enrolled in the Alabama Study on Early Age-Related Macular Degeneration (ALSTAR) were assessed for the presence of SDD using color fundus photos, infrared reflectance and fundus autofluorescence images, and spectral-domain optical coherence tomography volumes. The study sample included 799 eyes from 455 participants in normal macular health per grading of color fundus photographs using the 9-step Age-Related Eye Disease Study (AREDS) classification system. Age-related macular degeneration was defined as eyes having an AREDS grade ≥2 at the 3-year follow-up. Twenty-five percent of participants had SDD in one or both eyes at baseline. At follow-up visit, 11.9% of eyes in the sample developed AMD. Compared to eyes without SDD, those with SDD were 2.24 (95% confidence interval [CI] 1.36-3.70) times more likely to have AMD at follow-up. After adjusting for age, C-reactive protein quartile, and family history of AMD, the association persisted. Results suggest that SDD in older eyes with normal macular health as defined by the AREDS scale is a risk factor for the development of early AMD. Older adults in seemingly normal macular health yet having SDD may warrant closer clinical monitoring for the possible onset of early AMD.

  10. [Anophthalmos. Sequela of an unusual birth injury].

    PubMed

    Wiegand, W

    1990-01-01

    A child is reported who was born with complete absence of the right globe after instrumental delivery. The delivery was difficult and had been carried out by application of suction cup and forceps. The clinical examination at our hospital some days after the delivery suggested accidental enucleation during birth. In addition to anophthalmia, only minor laceration of the conjunctiva, a hematoma of the lids and a skin wound close to the right cheek were present, but no further orbital injuries. In earlier literature, similar injuries with luxation of the globe during delivery have been reported but they were usually associated with heavy periorbital injuries.

  11. Accidental introductions are an important source of invasive plants in the continental United States.

    PubMed

    Lehan, Nora E; Murphy, Julia R; Thorburn, Lukas P; Bradley, Bethany A

    2013-07-01

    Preventing new plant invasions is critical for reducing large-scale ecological change. Most studies have focused on the deliberate introduction of nonnatives via the ornamental plant trade. However, accidental introduction may be an important source of nonnative, invasive plants. Using Web and literature searches, we compiled pathways of introduction to the United States for 1112 nonnative plants identified as invasive in the continental United States. We assessed how the proportion of accidentally and deliberately introduced invasive plants varies over time and space and by growth habit across the lower 48 states. Deliberate introductions of ornamentals are the primary source of invasive plants in the United States, but accidental introductions through seed contaminants are an important secondary source. Invasive forbs and grasses are the most likely to have arrived accidentally through seed contaminants, while almost all nonnative, invasive trees were introduced deliberately. Nonnative plants invading eastern states primarily arrived deliberately as ornamentals, while a high proportion of invasive plants in western states arrived accidentally as seed contaminants. Accidental introductions may be increasing in importance through time. Before 1850, 10 of 89 (11%) of invasive plants arrived accidentally. After 1900, 20 of 65 (31%) arrived accidentally. Recently enacted screening protocols and weed risk assessments aim to reduce the number of potentially invasive species arriving to the United States via deliberate introduction pathways. Increasing proportions of accidentally introduced invasive plants, particularly associated with contaminated seed imports across the western states, suggest that accidental introduction pathways also need to be considered in future regulatory decisions.

  12. Phakic cystoid macular edema secondary to idiopathic macular telangiectasia type 1 responsive to topical anti-inflammatory agents.

    PubMed

    Dunn, Evan N; Gregori, Ninel Z; Goldhardt, Raquel

    2013-03-01

    To report a 65-year-old male patient with bilateral phakic cystoid macular edema secondary to idiopathic macular telangiectasia type 1, with robust response to topical steroidal and non-steroidal agents. Retrospective interventional case report. Chart review. Snellen visual acuity was 20/40 bilaterally. Color fundus photographs showing golden crystalline deposits temporal to the fovea; fluorescein angiography demonstrating telangiectasias with late leakage; and spectral-domain optical coherence tomography revealing intraretinal and subretinal fluid demonstrated findings consistent with idiopathic macular telangiectasia type 1 with bilateral cystoid macular edema. The patient was treated with steroidal and non-steroidal anti-inflammatory drops with complete resolution of edema within two months and improved visual acuity. Over the next two years, edema recurred whenever the drops were stopped and disappeared with reinstitution of topical therapy. Topical steroidal and non-steroidal anti-inflammatory agents may lead to long-term resolution of cystoid macular edema secondary to idiopathic macular telangiectasia type 1.

  13. Analysis of Facial Injuries Caused by Power Tools.

    PubMed

    Kim, Jiye; Choi, Jin-Hee; Hyun Kim, Oh; Won Kim, Sug

    2016-06-01

    The number of injuries caused by power tools is steadily increasing as more domestic woodwork is undertaken and more power tools are used recreationally. The injuries caused by the different power tools as a consequence of accidents are an issue, because they can lead to substantial costs for patients and the national insurance system. The increase in hand surgery as a consequence of the use of power tools and its economic impact, and the characteristics of the hand injuries caused by power saws have been described. In recent years, the authors have noticed that, in addition to hand injuries, facial injuries caused by power tools commonly present to the emergency room. This study aimed to review the data in relation to facial injuries caused by power saws that were gathered from patients who visited the trauma center at our hospital over the last 4 years, and to analyze the incidence and epidemiology of the facial injuries caused by power saws. The authors found that facial injuries caused by power tools have risen continually. Facial injuries caused by power tools are accidental, and they cause permanent facial disfigurements and functional disabilities. Accidents are almost inevitable in particular workplaces; however, most facial injuries could be avoided by providing sufficient operator training and by tool operators wearing suitable protective devices. The evaluation of the epidemiology and patterns of facial injuries caused by power tools in this study should provide the information required to reduce the number of accidental injuries.

  14. The Jamaica Injury Surveillance System: a profile of the intentional and unintentional injuries in Jamaican hospitals.

    PubMed

    Ward, E; McCartney, T; Arscott-Mills, S; Gordon, N; Grant, A; McDonald, A H; Ashley, D E

    2010-01-01

    Injuries in Jamaica are a major public health problem as demonstrated by a hospital based computerized injury surveillance system established in 1999 that provides a risk profile for injuries. Injury data from 2004 were selected to provide an annual profile, as comprehensive injury data were available from nine public hospitals. These nine public hospitals provide care for 70% of the Jamaicans admitted to hospitals annually. Data are presented on unintentional injuries where falls caused 44%, lacerations 27% and accidental blunt injuries were 17% of these. For motor vehicle related injuries, 55% were sustained while commuting by motorcars, 17% while riding motorbikes/bicycles and 16% of those injured were pedestrians. Most violence related injuries were due to fights (76%) with acquaintances (47%) who used sharp objects (40%) to inflict the injury. The Jamaica Injury Surveillance System (JISS) data, augmented by data collected on injuries from the health centres and the sentinel surveillance system, give a measure of the magnitude of the impact of injuries on the health services. The JISS provides data on the profile of injuries seen and treated at health facilities in Jamaica. In collaboration with police data and community-based surveys, it can be used to complete the risk profiles for different types of injuries. The data generated at the parish, regional and national levels form the basis for the design and monitoring of prevention programmes, as well as serve to support and evaluate policy, legislative control measures and measures that impact on interventions.

  15. Risk factors of age-related macular degeneration in Argentina.

    PubMed

    Nano, María Eugenia; Lansingh, Van Charles; Pighin, María Soledad; Zarate, Natalia; Nano, Hugo; Carter, Marissa Janine; Furtado, João Marcello; Nano, Clelia Crespo; Vernengo, Luciana Fiocca; Luna, José Domingo; Eckert, Kristen Allison

    2013-01-01

    To assess the risk factors of age-related macular degeneration in Argentina using a case-control study. Surveys were used for subjects' antioxidant intake, age/gender, race, body mass index, hypertension, diabetes (and type of treatment), smoking, sunlight exposure, red meat consumption, fish consumption, presence of age-related macular degeneration and family history of age-related macular degeneration. Main effects models for logistic regression and ordinal logistic regression were used to analyze the results. There were 175 cases and 175 controls with a mean age of 75.4 years and 75.5 years, respectively, of whom 236 (67.4%) were female. Of the cases with age-related macular degeneration, 159 (45.4%) had age-related macular degeneration in their left eyes, 154 (44.0%) in their right eyes, and 138 (39.4%) in both eyes. Of the cases with age-related macular degeneration in their left eyes, 47.8% had the dry type, 40.3% had the wet type, and the type was unknown for 11.9%. The comparable figures for right eyes were: 51.9%, 34.4%, and 13.7%, respectively. The main effects model was dominated by higher sunlight exposure (OR [odds ratio]: 3.3) and a family history of age-related macular degeneration (OR: 4.3). Other factors included hypertension (OR: 2.1), smoking (OR: 2.2), and being of the Mestizo race, which lowered the risk of age-related macular degeneration (OR: 0.40). Red meat/fish consumption, body mass index, and iris color did not have an effect. Higher age was associated with progression to more severe age-related macular degeneration. Sunlight exposure, family history of age-related macular degeneration, and an older age were the significant risk factors. There may be other variables, as the risk was not explained very well by the existing factors. A larger sample may produce different and better results.

  16. [Retina transplantation in exudative form of age-related macular degeneration].

    PubMed

    Figurska, Małgorzata; Stankiewicz, Andrzej

    2002-01-01

    The paper presents different techniques of macular translocation in exudative form of AMD, including particularly retinal detachment followed by retinotomy, limited macular translocation with chorioscleral infolding and outfolding by scleral imbrication.

  17. Three Studies Point to Same Risk Gene for Age-Related Macular Degeneration

    MedlinePlus

    ... point to same risk gene for age-related macular degeneration NIH-funded research helps unravel the biology of ... rare, but powerful risk factor for age-related macular degeneration (AMD), a common cause of vision loss in ...

  18. Ernest Borgnine Lays it on the Line Hollywood Hero Focuses on Macular Degeneration

    MedlinePlus

    ... it on the Line Hollywood Hero Focuses on Macular Degeneration Past Issues / Summer 2008 Table of Contents For ... going strong at 91, and speaking out on macular degeneration for the National Eye Institute. Photo courtesy of ...

  19. The spectrum of accidental childhood poisoning in the Caribbean.

    PubMed

    Martin, Thomas C; Brinkman, William

    2002-11-01

    To assess accidental poisoning in children in the Caribbean country of Antigua and Barbuda, including the incidence, the types of substances ingested, the age of the children involved, and the clinical outcomes. The results from Antigua and Barbuda were compared with the results of other reports from the English-speaking Caribbean and from the United States of America. We performed a retrospective review of the charts of all patients less than 13 years old admitted to the Children's Ward at Holberton Hospital in Antigua for accidental poisoning between March 1989 and March 1999. Those data were compared with data from earlier reports from Barbados, Guyana, Jamaica, and the United States of America. In Antigua and Barbuda there were 255 hospital admissions for accidental poisoning among children below 13 years old over that 10-year period. Of the 255 ingestions, 115 of them (45%) were in 1-year-old children, 69 (27%) were in 2-year-old children, and 26 (10%) were in 3-year-old children. These proportions in Antigua and Barbuda are similar to the age patterns seen in the other countries with which we made comparisons. In Antigua and Barbuda there was an annual average of 26 hospital admissions for poisoning for the roughly 20,000 children below 13 years of age, for a rate of 1.3 per 1,000. In comparing the patterns of childhood poisoning in all the countries we studied, we found that, as economic levels rose, there was a shift in the substances ingested, with hydrocarbon and plant ingestions decreasing and chemical and medication ingestions increasing. There is an increasing variety and complexity of poisonous substances ingested as economic conditions improve. This trend would make the establishment of a poison control center for the English-speaking Caribbean a logical step.

  20. Numerical simulation of industrial and accidental release formation and transport

    SciTech Connect

    Piskunov, V.N.; Aloyan, A.A.; Gerasimov, V.M.; Pinaev, V.S.; Golubev, A.I.; Yanilkin, Yu.V.; Ivanov, N.V.; Nikonov, S.N.; Kharchenko, A.I.

    1995-05-01

    Statement of work for contract 006 {open_quotes}Mathematical simulation of industrial and accidental release formation and transport{close_quotes} implies that the final result of the activity within this task will be VNIIEF developed techniques which will provide for the prediction of the post-accidental environment. Report [1] presents the description of physical models and calculation techniques which were chosen by VNIIEF to accomplish this task. These techniques were analysed for their capabilities, the areas of their application were defined, modifications within contract 006 were described, the results of test and methodical calculations were presented. Moreover, the experimental data were analysed over the source parameters and contamination measurements which can be used in the comparison with the calculation results. Based an these data this report compares the calculation results obtained with VNIIEF calculation techniques with the LANL-presented experimental results. The calculations which statements and results are given in section 1, included the following processes: explosion cloud ascent dynamics and jet release origin; aerosols kinetics in the release source including composite particle origin in the explosion cloud caused by radioactive substance sorption an the soil particles; contaminant transport in atmosphere and their in-site fallout due to the accidental explosions and fires; atmospheric flow dynamics and industrial contamination transfer over the complicated terrain. The calculated results were compared with the experimental data. Section 2 presents the parameters for a typical source in the explosion accidents based an the experimental results and calculated data from Section 1, as well as contamination patterns were calculated with basic technique {open_quotes}Prognosis{close_quotes}.

  1. Accidental outcomes guide punishment in a "trembling hand" game.

    PubMed

    Cushman, Fiery; Dreber, Anna; Wang, Ying; Costa, Jay

    2009-08-26

    How do people respond to others' accidental behaviors? Reward and punishment for an accident might depend on the actor's intentions, or instead on the unintended outcomes she brings about. Yet, existing paradigms in experimental economics do not include the possibility of accidental monetary allocations. We explore the balance of outcomes and intentions in a two-player economic game where monetary allocations are made with a "trembling hand": that is, intentions and outcomes are sometimes mismatched. Player 1 allocates $10 between herself and Player 2 by rolling one of three dice. One die has a high probability of a selfish outcome, another has a high probability of a fair outcome, and the third has a high probability of a generous outcome. Based on Player 1's choice of die, Player 2 can infer her intentions. However, any of the three die can yield any of the three possible outcomes. Player 2 is given the opportunity to respond to Player 1's allocation by adding to or subtracting from Player 1's payoff. We find that Player 2's responses are influenced substantially by the accidental outcome of Player 1's roll of the die. Comparison to control conditions suggests that in contexts where the allocation is at least partially under the control of Player 1, Player 2 will punish Player 1 accountable for unintentional negative outcomes. In addition, Player 2's responses are influenced by Player 1's intention. However, Player 2 tends to modulate his responses substantially more for selfish intentions than for generous intentions. This novel economic game provides new insight into the psychological mechanisms underlying social preferences for fairness and retribution.

  2. Evaluation and treatment of accidental autoinjection of epinephrine.

    PubMed

    Peyko, Vincent; Cohen, Victor; Jellinek-Cohen, Samantha P; Pearl-Davis, Michelle

    2013-05-01

    A case of accidental autoinjection of epinephrine is described. A 47-year-old man arrived at the emergency department after accidental injection of epinephrine with an autoinjector into his left thumb. His vital signs were stable at admission. The patient was allergic to nuts and thought he may have eaten something containing a pine nut. The patient reported feeling itching in his throat but had no shortness of breath or swollen tongue. He tried to self-administer an epinephrine injection, but it did not inject. While he was checking the device, it accidently injected into his left thumb pad. A review of systems revealed throat discomfort, a tingling sensation of the tongue, and a left-thumb puncture with pain. Physical examination of the left thumb pad revealed a pale, cool thumb with diminished capillary refill and punctuate black discoloration at the site of injection. Topical nitroglycerin paste was applied but had no effect, so terbutaline was ordered. The terbutaline injection was prepared as a 1:1 preparation of terbutaline sulfate 1 mg/mL and 0.9% sodium chloride injection. The immediate effects were the return of color from pale white to red and observable perfusion to the area within seconds. After 20 minutes, the red color remained, with observable perfusion and warmth, in addition to complete neurosensory function. Sixty minutes after terbutaline administration, the patient was discharged home. A 47-year-old man who accidentally injected himself in the thumb with an epinephrine autoinjector was successfully treated with subcutaneous terbutaline. The treatment had an immediate effect, including revascularization and resolution of pain.

  3. Outcome of accidental peritoneal dialysis catheter holes or tip exposure.

    PubMed

    Silverstein, Douglas M; Wilcox, Jennifer E

    2010-06-01

    Pediatric peritoneal dialysis (PD) patients are at risk for acute peritonitis. One risk factor is accidental exposure of the catheter to a non-sterile surface. We studied catheter exposures in 17 pediatric patients receiving PD who developed 16 holes and 12 other accidental exposures. The rate of exposures was 3.7 events/100 patient-months. After exposure, the mean counts (+ or - standard error) of white blood cells (WBC), red blood cells, and neutrophils were 39.8 + or - 19.3, 9.5 + or - 7.1, and 24.2 + or - 5.3/mm(3), respectively. There was a trend towards higher peritoneal fluid WBC in patients with holes than in those with exposures (60.1 + or - 34.8 vs. 15.4 + or - 5.1/mm(3), respectively; p = 0.2). The initial peritoneal fluid WBC count was significantly higher if there was a positive culture than a negative culture (165.0 + or - 132.6 vs. 20.3 + or - 6.4/mm(3), respectively; p = 0.01). The percentage of neutrophils was higher in patients with a positive culture than in those with a negative culture (54.7 + or - 14.1 vs. 19.1 + or - 4.9%, respectively; p = 0.01). Of the 28 patients, 27 received a single dose of intravenous antibiotics, as per the protocol at that time. Among those treated, 7% developed a positive culture (all staphylococcal species) while 93% had a negative culture. We conclude that following accidental exposure of the peritoneal dialysis catheter: (1) the prevalence of peritonitis is low; (2) measuring peritoneal fluid WBC provides treatment guidance; (3) if treatment is initiated, it should be applied intraperitoneally and include activity against Gram-positive organisms.

  4. Extrapyramidal symptoms following accidental ingestion of risperidone in a child.

    PubMed

    Cheslik, T A; Erramouspe, J

    1996-04-01

    To describe the development of extrapyramidal symptoms (EPS) precipitated by an accidental overdose of risperidone in a 3.5-year-old boy. The boy presented to the emergency department with bilateral upward eye gaze, jerky movements of his extremities, and motor restlessness following an accidental ingestion of a single 4-mg risperidone tablet. Decontamination with NaCl 0.9% lavage and activated charcoal with sorbitol was performed. His symptoms responded immediately to intravenous diphenhydramine (on 3 different occasions) during his first 9.5 hours of hospitalization. He experienced no additional EPS, and was discharged home approximately 33 hours following initial presentation. At home, he received three oral doses of diphenhydramine in the 24 hours following hospital discharge because of hand tremor, total body shivering, and eye wandering. These signs resolved without further complications. Although the incidence of EPS associated with therapeutic risperidone use is low, its occurrence following overdose is less clearly defined. This represents the first published case, to our knowledge, of risperidone overdose in a child and highlights the potential for dystonic reactions at low doses in this population. Seven intentional overdoses of risperidone in adults (aged 21-68 y) have been reported in the literature and are reviewed. Amounts ingested ranged from 5 to 270 mg. All adult patients appeared to have a relatively benign course. Reported symptoms included drowsiness, slurred speech, altered levels of consciousness, hypertension, tachycardia, electrocardiogram abnormalities, atypical motor behavior, tremors, and other EPS (not specified). Accidental ingestion of low doses of risperidone can cause EPS in children that may respond well to an anticholinergic agent. Overdose management includes gastrointestinal lavage, activated charcoal with cathartic, cardiovascular monitoring, and supportive therapy.

  5. Method and apparatus for controlling accidental releases of tritium

    DOEpatents

    Galloway, Terry R. [Berkeley, CA

    1980-04-01

    An improvement in a tritium control system based on a catalytic oxidation reactor wherein accidental releases of tritium into room air are controlled by flooding the catalytic oxidation reactor with hydrogen when the tritium concentration in the room air exceeds a specified limit. The sudden flooding with hydrogen heats the catalyst to a high temperature within seconds, thereby greatly increasing the catalytic oxidation rate of tritium to tritiated water vapor. Thus, the catalyst is heated only when needed. In addition to the heating effect, the hydrogen flow also swamps the tritium and further reduces the tritium release.

  6. Method and apparatus for controlling accidental releases of tritium

    DOEpatents

    Galloway, T.R.

    1980-04-01

    An improvement is described in a tritium control system based on a catalytic oxidation reactor wherein accidental releases of tritium into room air are controlled by flooding the catalytic oxidation reactor with hydrogen when the tritium concentration in the room air exceeds a specified limit. The sudden flooding with hydrogen heats the catalyst to a high temperature within seconds, thereby greatly increasing the catalytic oxidation rate of tritium to tritiated water vapor. Thus, the catalyst is heated only when needed. In addition to the heating effect, the hydrogen flow also swamps the tritium and further reduces the tritium release. 1 fig.

  7. [Intoxication from accidental ingestion of cannabis: analysis of eight cases].

    PubMed

    Patissier, C; Akdhar, M; Manin, C; Rosellini, D; Tambat, A; Tiprez, C; Wendremaire, P; Renoux, M-C

    2015-01-01

    Consultations at pediatric emergency units for acute consciousness alterations is frequent. Miscellaneous causes include cranial trauma, meningoencephalitis, metabolic disorders, drugs, or other intoxications. We report here eight cases of infants who were brought to the emergency division due to acute consciousness failure after accidental ingestion of hashish, confirmed by urinary dosage of Δ9-tetrahydrocannabinol. This series of under 24-month-old infants only emphasizes the value of screening for cannabis in urine in cases of abnormal consciousness and/or abnormal behavior in an infant.

  8. Staging of Macular Telangiectasia: Power-Doppler Optical Coherence Tomography and Macular Pigment Optical Density

    PubMed Central

    Chin, Eric K.; Kim, Dae Yu; Hunter, Allan A.; Pilli, Suman; Wilson, Machelle; Zawadzki, Robert J.; Werner, John S.; Park, Susanna S.

    2013-01-01

    Purpose. Two methods were used to study the stages of macular telangiectasia (MacTel): Power-Doppler optical coherence tomography (PD-OCT), which allows imaging of the retinal circulation in three dimensions, and macular pigment optical density (MPOD), which quantifies the distribution of macular carotenoids. Methods. Among 49 patients with MacTel identified, 12 eyes (6 patients) with MacTel and 7 age-matched control eyes (7 patients) were imaged with a custom-built Fourier-domain OCT instrument to acquire PD-OCT images. MPOD was measured using heterochromatic flicker photometry in 10 eyes (5 patients) with MacTel and compared with 44 age-matched control eyes (44 patients). Clinical staging of MacTel was based on best-corrected visual acuity, fundus biomicroscopy, fluorescein angiography, and OCT. Results. Stage 1 eyes (n = 2) had subtle punctate vascular signal confined to the inner portion of the outer plexiform layer (OPL) on PD-OCT. Stage 2 (n = 2) showed larger oblique vascular signal extending into deeper OPL. Stage 3 (n = 5) had disruption of outer retinal layers with abnormal vasculature extending into the outer nuclear layer. Stage 4 (n = 3) showed diffuse blurring of the retinal layers with vascular channels extending the full thickness of the retina. MPOD values in four eyes with stage 1 or 2 MacTel correlated well with age-matched controls. Six eyes with stage 3 or 4 MacTel had loss of MPOD especially at the fovea. Conclusions. PD-OCT shows penetration of the retinal capillaries into the deeper retinal layers in early stages of MacTel, with full thickness vascular proliferation in advanced disease. MPOD is commonly depleted but may appear normal in early stage MacTel. PMID:23716628

  9. Two-wavelength fundus autofluorescence and macular pigment optical density imaging in diabetic macular oedema.

    PubMed

    Waldstein, S M; Hickey, D; Mahmud, I; Kiire, C A; Charbel Issa, P; Chong, N V

    2012-08-01

    To evaluate the application of 488 and 514 nm fundus autofluorescence (FAF) and macular pigment optical density (MPOD) imaging in diabetic macular oedema (DMO) and to demonstrate the typical imaging features. A hundred and twenty-five eyes of 71 consecutive patients with diabetic retinopathy who underwent examination at a specialist university clinic employing a modified Heidelberg Retina Angiograph, using two different light sources of 488 and 514 nm wavelength, were retrospectively reviewed. MPOD images were calculated using modified Heidelberg Eye Explorer software. All images were evaluated by two independent masked graders. Features from FAF and MPOD images were correlated with optical coherence tomography (OCT) imaging findings and inter-grader variability, sensitivity and specificity were calculated using OCT as reference. Sixty-seven eyes had DMO on OCT. The inter-grader variability was 0.84 for 488 nm FAF, 0.63 for 514 nm FAF and 0.79 for MPOD imaging. Sensitivity and specificity for detection of DMO were 80.6 and 89.7% for 488 nm FAF; 55.2 and 94.8% for 514 nm FAF; and 80.6 and 91.4% for MPOD imaging. In 488 nm FAF and MPOD imaging, DMO was better visualised in comparison with 514 nm FAF imaging, P<0.01. MPOD revealed displacement of macular pigment by intraretinal cysts. MPOD imaging, and particularly its combination with 488 nm and 514 nm FAF, provides a valuable addition to OCT in the evaluation of DMO and is clinically useful in rapid en-face assessment of the central macula.

  10. Macular xanthophylls, lipoprotein-related genes, and age-related macular degeneration1234

    PubMed Central

    Koo, Euna; Neuringer, Martha; SanGiovanni, John Paul

    2014-01-01

    Plant-based macular xanthophylls (MXs; lutein and zeaxanthin) and the lutein metabolite meso-zeaxanthin are the major constituents of macular pigment, a compound concentrated in retinal areas that are responsible for fine-feature visual sensation. There is an unmet need to examine the genetics of factors influencing regulatory mechanisms and metabolic fates of these 3 MXs because they are linked to processes implicated in the pathogenesis of age-related macular degeneration (AMD). In this work we provide an overview of evidence supporting a molecular basis for AMD-MX associations as they may relate to DNA sequence variation in AMD- and lipoprotein-related genes. We recognize a number of emerging research opportunities, barriers, knowledge gaps, and tools offering promise for meaningful investigation and inference in the field. Overviews on AMD- and high-density lipoprotein (HDL)–related genes encoding receptors, transporters, and enzymes affecting or affected by MXs are followed with information on localization of products from these genes to retinal cell types manifesting AMD-related pathophysiology. Evidence on the relation of each gene or gene product with retinal MX response to nutrient intake is discussed. This information is followed by a review of results from mechanistic studies testing gene-disease relations. We then present findings on relations of AMD with DNA sequence variants in MX-associated genes. Our conclusion is that AMD-associated DNA variants that influence the actions and metabolic fates of HDL system constituents should be examined further for concomitant influence on MX absorption, retinal tissue responses to MX intake, and the capacity to modify MX-associated factors and processes implicated in AMD pathogenesis. PMID:24829491

  11. [Transmissing electron microscopy of the vitreo-macular border in clinically significant diabetic macular edema].

    PubMed

    Synek, S; Pác, L; Synková, M

    2007-09-01

    The authors examined samples of the epimacular tissue in clinically significant macular edema by means of the transmissing electron microscopy. They did not found morphological differences between samples from patients already treated by means of laser photocoagulation before the pars plana vitrectomy and those without the laser treatment. Findings may be divided into three groups: (1) the inner limiting membrane (ILM) covered with collagen vitreous fibers, (2) cells' elements of the fibroblasts category, and (3) fibrous astrocytes in the vitreous cortex constituting one- or multilayer cellular membranes.

  12. Macular morphology and visual acuity in the comparison of age-related macular degeneration treatments trials.

    PubMed

    Jaffe, Glenn J; Martin, Daniel F; Toth, Cynthia A; Daniel, Ebenezer; Maguire, Maureen G; Ying, Gui-Shuang; Grunwald, Juan E; Huang, Jiayan

    2013-09-01

    To describe the effects of treatment for 1 year with ranibizumab or bevacizumab on macular morphology and the association of macular morphology with visual acuity (VA) in eyes with neovascular age-related macular degeneration (AMD). Prospective cohort study within a randomized clinical trial. Participants in the Comparison of Age-related Macular Degeneration Treatments Trials. Participants were assigned randomly to treatment with ranibizumab or bevacizumab on a monthly or as-needed schedule. Optical coherence tomography (OCT), fluorescein angiography (FA), color fundus photography (FP), and VA testing were performed periodically throughout 52 weeks. Masked readers graded images. General linear models were applied to evaluate effects of time and treatment on outcomes. Fluid type and location and thickness by OCT, size, and lesion composition on FP, FA, and VA. Intraretinal fluid (IRF), subretinal fluid (SRF), subretinal pigment epithelium fluid, and retinal, subretinal, and subretinal tissue complex thickness decreased in all treatment groups. A higher proportion of eyes treated monthly with ranibizumab had fluid resolution at 4 weeks, and the difference persisted through 52 weeks. At 52 weeks, there was little association between the presence of fluid of any type (without regard to fluid location) and the mean VA. However, at all time points, eyes with residual IRF, especially foveal IRF, had worse mean VA (9 letters) than those without IRF. Eyes with abnormally thin (<120 μm) or thick (>212 μm) retinas had worse VA than those with normal thickness (120-212 μm). At week 52, eyes with larger neovascular lesions or with foveal scar had worse VA than eyes without these features. Anti-vascular endothelial growth factor (VEGF) therapy reduced lesion activity and improved VA in all treatment groups. At all time points, eyes with residual IRF had worse VA than those without. Eyes with abnormally thin or thick retinas, residual large lesions, and scar also had worse VA

  13. Age related macular degeneration and visual disability.

    PubMed

    Christoforidis, John B; Tecce, Nicola; Dell'Omo, Roberto; Mastropasqua, Rodolfo; Verolino, Marco; Costagliola, Ciro

    2011-02-01

    Age-related macular degeneration (AMD) is the leading cause of central blindness or low vision among the elderly in industrialized countries. AMD is caused by a combination of genetic and environmental factors. Among modifiable environmental risk factors, cigarette smoking has been associated with both the dry and wet forms of AMD and may increase the likelihood of worsening pre-existing AMD. Despite advances, the treatment of AMD has limitations and affected patients are often referred for low vision rehabilitation to help them cope with their remaining eyesight. The characteristic visual impairment for both forms of AMD is loss of central vision (central scotoma). This loss results in severe difficulties with reading that may be only partly compensated by magnifying glasses or screen-projection devices. The loss of central vision associated with the disease has a profound impact on patient quality of life. With progressive central visual loss, patients lose their ability to perform the more complex activities of daily living. Common vision aids include low vision filters, magnifiers, telescopes and electronic aids. Low vision rehabilitation (LVR) is a new subspecialty emerging from the traditional fields of ophthalmology, optometry, occupational therapy, and sociology, with an ever-increasing impact on the usual concepts of research, education, and services for visually impaired patients. Relatively few ophthalmologists practise LVR and fewer still routinely use prismatic image relocation (IR) in AMD patients. IR is a method of stabilizing oculomotor functions with the purpose of promoting better function of preferred retinal loci (PRLs). The aim of vision rehabilitation therapy consists in the achievement of techniques designed to improve PRL usage. The use of PRLs to compensate for diseased foveae has offered hope to these patients in regaining some function. However, in a recently published meta-analysis, prism spectacles were found to be unlikely to be of

  14. Reduced macular function in ABCA4 carriers

    PubMed Central

    2015-01-01

    carriers demonstrated reduced macular function measured by mERG along with none to subtle and even extensive morphological retinal changes. The c.768 G>T, c.5461–10T>C, and c.319 C>T mutations were associated with the most deviant ERGs, including both significant reduction of mERG amplitudes and prolongation of mERG ITs, as well as with reduced amplitude or delayed IT for the 30 Hz flicker ffERG in a few cases. They may therefore be considered serious mutations. The c.5917delG and c.4469 G>A mutations were associated with milder or no macular alteration. Long-term follow-up of these and other ABCA4 carriers may be of importance to elucidate the role of ABCA4 mutations in age-related macular degeneration. Moreover, improved knowledge of separate ABCA4 mutations may help us to better understand their role in ABCA4-associated retinal degenerations. PMID:26261413

  15. Higher Irradiance and Photodynamic Therapy for Age-Related Macular Degeneration (An AOS Thesis)

    PubMed Central

    Miller, Joan W.

    2008-01-01

    Purpose Photodynamic therapy (PDT) using verteporfin was the first pharmacologic therapy for neovascular age-related macular degeneration and changed the treatment paradigm for a major, blinding disease. The experimental work in the nonhuman primate was essential in developing treatment parameters for verteporfin PDT that could successfully occlude choroidal neovascularization with limited injury to the neural retina. Early in the preclinical primate studies, we hypothesized that higher irradiances could be used for ocular PDT than had been used in dermatology and other applications, which typically utilized an irradiance of 150 to 200 mW/cm2. We set out to test the feasibility of irradiances up to 1800 mW/cm2. Methods PDT was applied to normal monkey eyes using verteporfin/benzoporphyrin derivative (BPD) (2 mg/kg) mixed with low-density lipoprotein in DMSO, and 692-nm light, with a spot size 1250μm, fluence approximately 50 J/cm2, and irradiance varying from 150 (treatment time, 6 minutes) to 1800 mW/cm2 (treatment time, 30 seconds). Photocoagulation lesions were applied using 514-nm and 692-nm laser light without drug, with irradiance of 18,750 to 200,000 mW/cm2 and spot size of 500 μm. Treatment effect was evaluated by fundus photography, angiography, and light and electron microscopy with collagen denaturation as a marker of thermal injury. Results Verteporfin/BPD PDT at irradiances of 150 to 1800 mW/cm2 showed no collagen denaturation in contrast to photocoagulation lesions without dye (irradiance 10-fold and higher). Conclusions Verteporfin PDT could safely be performed at higher irradiances, permitting a clinically practical therapy. Ultimately, clinical trials demonstrated that verteporfin PDT could limit moderate vision loss in neovascular age-related macular degeneration. Although anti-VEGF therapy has replaced PDT as a first-line therapy, PDT may still have a role, perhaps in combination therapies. Further investigations to optimize drug delivery and

  16. Statins for age-related macular degeneration

    PubMed Central

    Gehlbach, Peter; Li, Tianjing; Hatef, Elham

    2014-01-01

    Background Age-related macular degeneration (AMD) is a progressive late onset disorder of the macula affecting central vision. Age-related macular degeneration is the leading cause of blindness in people over 65 years in industrialized countries (Congdon 2003). Recent epidemiologic, genetic and pathological evidence has shown AMD shares a number of risk factors with atherosclerosis, leading to the hypothesis that statins may exert protective effects in AMD. Objectives To examine the effectiveness of statins compared with other treatments, no treatment, or placebo in delaying the onset and/or progression of AMD. Search strategy We searched CENTRAL in The Cochrane Library, MEDLINE, EMBASE and LILACS on 30 April 2009 and the WHO International Clinical Trials Registry Platform on 11 May 2009. We searched reference lists and the Science Citation Index. There were no language or date restrictions in the search for trials. Selection criteria We included randomized controlled trials (RCTs) that compared statins with other treatments, no treatment, or placebo in participants who were either susceptible to or diagnosed as having early stages of AMD. Data collection and analysis Two authors independently evaluated the search results against the selection criteria. Two Italian speaking colleagues extracted data. One author entered data. We did not perform a meta-analysis because only one completed RCT was identified. Main results Two studies met the selection criteria. One trial reported insufficient details to assess the risk of bias; the other trial is ongoing. Of the completed trial, the analyses of 30 participants did not show a statistically significant difference between the simvastatin and the placebo arm in visual acuity at three months of treatment (decimal visual acuity 0.21± 0.56 in simvastatin and 0.19± 0.40 in placebo arm) or 45 days after the completion of treatment (decimal visual acuity 0.20± 0.50 in simvastatin and 0.19± 0.48 in placebo arm). The lens and

  17. Multidisciplinary approach to "accidental" falls in the elderly: a case report.

    PubMed

    Galizia, Gianluigi; Testa, Gianluca; Mazzella, Francesca; Cacciatore, Francesco; Ungar, Andrea; Masotti, Giulio; Rengo, Franco; Abete, Pasquale

    2008-06-01

    Falls in the elderly are commonly and often wrongly identified as "accidental". We report a case of an elderly woman admitted to first aid for a trauma due to an accidental fall. Geriatric multidisciplinary evaluation revealed mild cognitive impairment associated with depressive symptoms; both findings made the anamnesis uncertain. Syncope algorithm was applied and "tachy-brady form of sick sinus syndrome" was diagnosed. Differential diagnosis between "accidental" and "apparently accidental" falls in elderly patients is very difficult but a multidisciplinary geriatric evaluation can clarify the correct diagnosis.

  18. Small bowel perforations due to deliberate ingestion of injurious foreign bodies--a personal experience.

    PubMed

    Malik, Arshad M

    2008-01-01

    Ingestion of foreign bodies is not an uncommon problem in our society. The patients usually ingest different types of foreign bodies either accidentally or deliberately. Rare in children but adults are not uncommonly affected and are either psychiatric patients or ingest foreign bodies accidentally. Life threatening complications may occur at times due to ingestion of sharp and pointed objects. An interesting case of ingestion of multiple injurious foreign bodies presenting with multiple small intestinal perforations is presented with review of literature.

  19. Adolescent Orofacial Injury: Association with Psychological Symptoms

    PubMed Central

    Murphy, Debra A.; Shetty, Vivek; Herbeck, Diane M.; Der-Martirosian, Claudia; Urata, Mark; Yamashita, Dennis-Duke

    2011-01-01

    Ethnic minority youth living in urban areas experience disproportionately high rates of violent intentional injuries. This study investigates the association of violent intentional injuries with psychological distress and alcohol use among adolescents treated in trauma centers for facial injuries. Interviews were conducted with 67 adolescents treated at two urban trauma centers (predominantly male [86%], and minority [Latino, 72%; African American, 19%]). Adolescents reported experiencing several different types of accidental and assault-related injuries that required medical attention in the past six months. About half (53%) reported experiencing only unintentional injuries (e.g., car accidents, falls, sports injury); 23% experienced one type of intentional injury resulting from either fighting or being attacked; and 24% experienced two types of intentional injuries resulting from both fighting and being attacked. Measures of alcohol use and psychological distress were examined in relation to these three types of injuries. Overall, 30% of study participants reported they had been drinking alcohol at the time of injury. Compared to adolescents without intentional injuries, those who experienced a physical fight and/or attack had higher levels of alcohol problems, depression, paranoia and somatic symptoms, and were more likely to have family members with alcohol problems. There is a considerable need for adolescents with intentional assault-related injuries to be screened for alcohol and mental health problems, and to be referred for appropriate treatment interventions if they score at problem levels. PMID:20835967

  20. A historical perspective: Simian AIDS-an accidental windfall.

    PubMed

    Gardner, Murray

    2016-10-01

    For the past 30 years, Simian AIDS has provided an indispensible animal model for the human disease. This historical perspective highlights the circumstances leading to the creation of this experimental model. Historical information and stored non-human primate (NHP) specimens, including isolates of Simian immunodeficiency virus (SIV), were analyzed by molecular epidemiologic methods to trace the lineage and transmission of SIV among NHPs at US primate centers. The rhesus and stump-tailed macaque models of Simian AIDS are the result of the accidental transmission of SIV from healthy sooty mangabey carriers to naïve macaques during the course of human kuru experimental transmission studies at UC Davis during the 1960s. Simian AIDS, first recognized in the 1980s, is the accidental result of experimental kuru transmission experiments carried out in the 1960s, which led to the discovery of infectious prions but inadvertently transmitted SIV, unknown at that time, from sooty mangabeys to macaques. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  1. Accidental acute alcohol intoxication in infants: review and case report.

    PubMed

    Minera, Gabriella; Robinson, Evan

    2014-11-01

    Acute alcohol intoxication in children younger than 18 months old is both rarely documented and rarely fatal. Previous case reports suggest hypoglycemia and faster than normal rates of alcohol elimination found in children with acute alcohol intoxication compared with adults, but data are lacking. A 2-month-old infant presented with a decreased mental status after accidental ingestion of alcohol. He was diagnosed with acute alcohol intoxication, with a blood alcohol level of 330 mg/dL and was hyperglycemic (167 mg/dL). Alcohol elimination rate was calculated to be 21.6 mg/dL/h, similar to that in adults. To our knowledge, this case is the second youngest documented patient with accidental alcohol intoxication via ingestion in the United States. We present a rare case report of acute alcohol intoxication in an infant and a review of the literature. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Although rare in the literature, poison control data suggests that alcohol poisoning in very young children is not rare. Emergency physicians should be prepared for the management of infants with alcohol poisoning. This case report and review brings attention to this subject and briefly discusses ethanol metabolism in infants. Copyright © 2014 Elsevier Inc. All rights reserved.

  2. Preventing Accidental Ignition of Upper-Stage Rocket Motors

    NASA Technical Reports Server (NTRS)

    Hickman, John; Morgan, Herbert; Cooper, Michael; Murbach, Marcus

    2005-01-01

    A report presents a proposal to reduce the risk of accidental ignition of certain upper-stage rocket motors or other high energy hazardous systems. At present, mechanically in-line initiators are used for initiation of many rocket motors and/or other high-energy hazardous systems. Electrical shorts and/or mechanical barriers, which are the basic safety devices in such systems, are typically removed as part of final arming or pad preparations while personnel are present. At this time, static discharge, test equipment malfunction, or incorrect arming techniques can cause premature firing. The proposal calls for a modular out-of-line ignition system incorporating detonating-cord elements, identified as the donor and the acceptor, separated by an air gap. In the safe configuration, the gap would be sealed with two shields, which would prevent an accidental firing of the donor from igniting the system. The shields would be removed to enable normal firing, in which shrapnel generated by the donor would reliably ignite the acceptor to continue the ordnance train. The acceptor would then ignite a through bulkhead initiator (or other similar device), which would ignite the motor or high-energy system. One shield would be remotely operated and would be moved to the armed position when a launch was imminent or conversely returned to the safe position if the launch were postponed. In the event of failure of the remotely operated shield, the other shield could be inserted manually to safe the system.

  3. Accidental Peccei-Quinn Symmetry Protected to Arbitrary Order

    NASA Astrophysics Data System (ADS)

    Di Luzio, Luca; Nardi, Enrico; Ubaldi, Lorenzo

    2017-07-01

    A S U (N )L×S U (N )R gauge theory for a scalar multiplet Y transforming in the bifundamental representation (N ,N ¯) preserves, for N >4 , an accidental U (1 ) symmetry first broken at operator dimension N . A vacuum expectation value for Y can break the symmetry to Hs=S U (N )L+R or to Hh=S U (N -1 )L×S U (N -1 )R×U (1 )L +R . In the first case the accidental U (1 ) gets also broken, yielding a pseudo-Nambu-Goldstone boson with mass suppression controlled by N . In the second case a global U (1 ) remains unbroken. The strong C P problem is solved by coupling Y to new fermions carrying color. The first case allows for a Peccei-Quinn solution with U (1 )PQ protected by the gauge symmetry up to order N . In the second case U (1 ) can get broken by condensates of the new strong dynamics, resulting in a composite axion. By coupling Y to fermions carrying only weak isospin, models for axionlike particles can be constructed.

  4. Epidemiology of accidental home poisoning in Riyadh (Saudi Arabia).

    PubMed Central

    Mahdi, A H; Taha, S A; Al Rifai, M R

    1983-01-01

    In a prospective study on 178 cases of accidental home poisoning admitted to the main children's hospital in Riyadh poisoning was found to account for 5.6% of the total annual admissions--greater than any other developing country and approaching Western proportions. The commonest ages were between 1 and 5 years. Drugs accounted for 52% of cases and household products for 46%. This picture also differs from the pattern of poisoning in developing countries and is more akin to that of industrialised countries. The most important factors in aetiology, besides the age of the patient and the underprivileged social class, were the abundance of drugs and household chemicals in the Saudi home, none of them in child proof containers; inappropriate storage; and lack of supervision of children. Cultural factors also contributed. The frequency of poisoning in childhood may be decreased in the long run by improved housing, socioeconomic status, and education. The place and methods of health education, also a long term objective, is discussed. For immediate primary prevention two important legislative measures are proposed: (1) provision of childproof containers of drugs and other chemicals used in the home and (2) banning of over the counter sales of drugs. For more accurate epidemiological data collection, and thereby better preventative planning, a national register of accidental poisoning and other accidents is recommended. Poison information centres are also deemed necessary. PMID:6655419

  5. Forensic aspects of 40 accidental autoerotic deaths in Northern Germany.

    PubMed

    Janssen, W; Koops, E; Anders, S; Kuhn, S; Püschel, K

    2005-01-17

    Between 1983 and 2003, 40 accidental autoerotic fatalities have been investigated. in the Institute of Legal Medicine in Hamburg. Only 50% (n=20) were autopsied (13 legal autopsies, 6 for scientific purposes and 1 for an insurance company). All the victims were males, aged between 13 and 79 years (among them five children and adolescents, the deceased mainly between 20 and 40 years). The paraphiliacs utilized a great range of devices and props as fetishism, sexual aids or pain-stimulating agents, like intimate feminine garments, ropes, chains, bondages, locks, pornographic magazines, condoms, rubber items, and chemical anaesthetics. The cause of death was strangulation in 20 cases (17 x hanging, 3 x ligature strangulation), 11 x suffocation (8 x under plastic bags, 3 x with face-masks, 2 x thoracic compression, 1 x positional asphyxia, and 1 x cocaine intoxication). Five cases without autopsy remained unclear because of missing morphological and toxicological findings; it could not be differentiated between asphyxiation/intoxication/natural disease, although the scene characteristics seemed to be typical for autoerotic deaths. It is emphasized that the findings at the scene, the morphological and toxicological examination of the dead body (full autopsy as prerequisite) by experienced investigators and the personal history of the deceased have to be evaluated very carefully and intensely to reconstruct the accidental fatal autoerotic course accurately and undoubtedly (to exclude the possibility of sexual homicide, neglected killing, or suicide).

  6. Incidence and characteristics of accidental falls in hospitalizations.

    PubMed

    Kobayashi, Kazuyoshi; Imagama, Shiro; Inagaki, Yuko; Suzuki, Yusuke; Ando, Kei; Nishida, Yoshihiro; Nagao, Yoshimasa; Ishiguro, Naoki

    2017-08-01

    Aging of the patient population has led to increased occurrence of accidental falls in acute care settings. The aim of this study is to survey the annual occurrence of falls in a university hospital, and to examine procedures to prevent fall. A total of 49,059 inpatients were admitted to our hospital from April 2015 to March 2016. A fall assessment scale was developed to estimate the risk of fall at admission. Data on falls were obtained from the hospital incident reporting system. There were fall-related incidents in 826 patients (1.7%). Most falls occurred in hospital rooms (67%). Adverse events occurred in 101 patients who fell (12%) and were significantly more frequent in patients aged ≥80 years old and in those wearing slippers. The incidence of falls was also significantly higher in patients in the highest risk group. These results support the validity of the risk assessment scale for predicting accidental falls in an acute treatment setting. The findings also clarify the demographic and environmental factors and consequences associated with fall. These results of the study could provide important information for designing effective interventions to prevent fall in elderly patients.

  7. Retrobulbar gas after macular hole surgery: a case report.

    PubMed

    Roth, Daniel B; Ballintine, Sheila D

    2013-01-01

    To present a case of a patient who underwent vitreoretinal surgery for repair of a full-thickness macular hole and received an inappropriate concentration of C3F8 gas. Interventional case report. A 63-year-old man with a Stage IV full-thickness macular hole underwent uneventful macular hole surgery. The vitreous cavity was filled with presumed 16% perfluoropropane (C3F8) gas and none of the sclerotomies were sutured closed. Postoperatively, the patient presented with severe pain and proptosis and a visual acuity of count fingers. His condition was managed initially with a vitreous gas tap after which an emergency computed tomography was performed revealing retrobulbar air. The patient returned to the operating room and underwent surgical decompression of the retrobulbar gas. Despite medical management to manage his intraocular pressure, the patient required a second vitreous tap. By Postoperative Day 10 after his original macular hole surgery, the gas fill of the posterior segment started to decrease, his proptosis had resolved, and his pain had diminished. By Postoperative Day 60, the macular hole closed and the optic nerve exhibited no pallor or cupping. Despite an inappropriate concentration of gas being used, the unsutured sclerotomies allowed escape of the gas from the vitreous space, buffering the rise in intraocular pressure and preventing complete vascular occlusion.

  8. Intravitreal injection of Bevacizumab in diabetic macular edema

    PubMed Central

    Ateeq, Asim; Tahir, Muhammad Ali; Cheema, Alyscia; Dahri, Arif; Tareen, Saifullah

    2014-01-01

    Objective: To assess the effectiveness of intravitreal injection of Bevacizumab in the treatment of diabetic macular edema. Methods: This case series was conducted at Department of Ophthalmology, Jinnah Post Graduate Medical Centre (JPMC), Karachi. The duration of study was six months from May 26, 2011 to November 25, 2011. The study group comprised of 54 patients of the Diabetic Macular Edema (DME). Intravitreal injection of 1.25 mg of bevacizumab (Avastin) was injected 3.5 mm from the limbus under topical anaesthetic drops. Post procedure follow up was scheduled on 1st post procedure day and after one month. Post procedure Optical Coherence tomography (OCT) was performed in all patients 1 week before and 1st month after 1st injection. The results were statistically analyzed through SPSS 17. Results: Out of the 54 Eyes of 54 Patients who were given the Intravitreal injection of Avastin (Bevacizumab), 43 Eyes (79.6%) showed more than ten percent decrease in macular thickness from pre-injection thickness, 10 Eyes (18.5%) showed less than ten percent decrease and 1 Eye (1.9%) showed increase in macular thickness post operatively after one month. Conclusions: Intravitreal injection of Bevacizumab (Avastin) is effective in the treatment of diabetic macular edema. PMID:25674143

  9. Parainflammation, chronic inflammation, and age-related macular degeneration.

    PubMed

    Chen, Mei; Xu, Heping

    2015-11-01

    Inflammation is an adaptive response of the immune system to noxious insults to maintain homeostasis and restore functionality. The retina is considered an immune-privileged tissue as a result of its unique anatomic and physiologic properties. During aging, the retina suffers from a low-grade chronic oxidative insult, which sustains for decades and increases in level with advancing age. As a result, the retinal innate-immune system, particularly microglia and the complement system, undergoes low levels of activation (parainflammation). In many cases, this parainflammatory response can maintain homeostasis in the healthy aging eye. However, in patients with age-related macular degeneration, this parainflammatory response becomes dysregulated and contributes to macular damage. Factors contributing to the dysregulation of age-related retinal parainflammation include genetic predisposition, environmental risk factors, and old age. Dysregulated parainflammation (chronic inflammation) in age-related macular degeneration damages the blood retina barrier, resulting in the breach of retinal-immune privilege, leading to the development of retinal lesions. This review discusses the basic principles of retinal innate-immune responses to endogenous chronic insults in normal aging and in age-related macular degeneration and explores the difference between beneficial parainflammation and the detrimental chronic inflammation in the context of age-related macular degeneration. © Society for Leukocyte Biology.

  10. Relationship between macular pigment and visual function in subjects with early age-related macular degeneration.

    PubMed

    Akuffo, Kwadwo Owusu; Nolan, John M; Peto, Tunde; Stack, Jim; Leung, Irene; Corcoran, Laura; Beatty, Stephen

    2017-02-01

    To investigate the relationship between macular pigment (MP) and visual function in subjects with early age-related macular degeneration (AMD). 121 subjects with early AMD enrolled as part of the Central Retinal Enrichment Supplementation Trial (CREST; ISRCTN13894787) were assessed using a range of psychophysical measures of visual function, including best corrected visual acuity (BCVA), letter contrast sensitivity (CS), mesopic and photopic CS, mesopic and photopic glare disability (GD), photostress recovery time (PRT), reading performance and subjective visual function, using the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25). MP was measured using customised heterochromatic flicker photometry. Letter CS, mesopic and photopic CS, photopic GD and mean reading speed were each significantly (p<0.05) associated with MP across a range of retinal eccentricities, and these statistically significant relationships persisted after controlling for age, sex and cataract grade. BCVA, NEI VFQ-25 score, PRT and mesopic GD were unrelated to MP after controlling for age, sex and cataract grade (p>0.05, for all). MP relates positively to many measures of visual function in unsupplemented subjects with early AMD. The CREST trial will investigate whether enrichment of MP influences visual function among those afflicted with this condition. ISRCTN13894787. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  11. Diabetic macular edema, retinopathy and age-related macular degeneration as inflammatory conditions

    PubMed Central

    2016-01-01

    Diabetic macular edema (DME) and diabetic retinopathy (DR) are complications affecting about 25% of all patients with long-standing type 1 and type 2 diabetes mellitus and are a major cause of significant decrease in vision and quality of life. Age-related macular degeneration (AMD) is not uncommon, and diabetes mellitus affects the incidence and progression of AMD through altering hemodynamics, increasing oxidative stress, accumulating advanced glycation end products, etc. Recent studies suggest that DME, DR and AMD are inflammatory conditions characterized by a breakdown of the blood-retinal barrier, inflammatory processes and an increase in vascular permeability. Key factors that seem to have a dominant role in DME, DR and AMD are angiotensin II, prostaglandins and the vascular endothelial growth factor and a deficiency of anti-inflammatory bioactive lipids. The imbalance between pro- and anti-inflammatory eicosanoids and enhanced production of pro-angiogenic factors may initiate the onset and progression of DME, DR and AMD. This implies that bioactive lipids that possess anti-inflammatory actions and suppress the production of angiogenic factors could be employed in the prevention and management of DME, DR and AMD. PMID:27695506

  12. Gene therapy in age related macular degeneration and hereditary macular disorders.

    PubMed

    Kinnunen, Kati; Yla-Herttuala, Seppo

    2012-06-01

    In ophthalmology, administration of the therapeutic agent can be difficult due to the tight barriers in the eye. Multiple injections may be needed to allow the therapeutic agent to reach adequate levels in retina and choroidea which may increase the risk of complications including endophthalmitis, cataract and haemorrhages. Optimal methods for the delivery of therapeutic agents to the posterior segments of the eye have not yet been developed. Gene therapy offers an alternative where the therapeutic protein or proteins can be induced in the target tissue for a prolonged period of time after a single injection. The eye is a promising target for gene therapy due to its small size and tissue boundaries preventing leakage of the therapeutic material to other tissues or systemic circulation. However, most of the work in ocular gene therapy is still at the preclinical phase; only three vectors have reached phase 1/2 clinical trials. This review summarizes basic principles and current status of gene therapy in age related macular degeneration and hereditary macular disorders.

  13. Relationship between macular pigment and visual function in subjects with early age-related macular degeneration

    PubMed Central

    Nolan, John M; Peto, Tunde; Stack, Jim; Leung, Irene; Corcoran, Laura; Beatty, Stephen

    2017-01-01

    Purpose To investigate the relationship between macular pigment (MP) and visual function in subjects with early age-related macular degeneration (AMD). Methods 121 subjects with early AMD enrolled as part of the Central Retinal Enrichment Supplementation Trial (CREST; ISRCTN13894787) were assessed using a range of psychophysical measures of visual function, including best corrected visual acuity (BCVA), letter contrast sensitivity (CS), mesopic and photopic CS, mesopic and photopic glare disability (GD), photostress recovery time (PRT), reading performance and subjective visual function, using the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25). MP was measured using customised heterochromatic flicker photometry. Results Letter CS, mesopic and photopic CS, photopic GD and mean reading speed were each significantly (p<0.05) associated with MP across a range of retinal eccentricities, and these statistically significant relationships persisted after controlling for age, sex and cataract grade. BCVA, NEI VFQ-25 score, PRT and mesopic GD were unrelated to MP after controlling for age, sex and cataract grade (p>0.05, for all). Conclusions MP relates positively to many measures of visual function in unsupplemented subjects with early AMD. The CREST trial will investigate whether enrichment of MP influences visual function among those afflicted with this condition. Trial registration number ISRCTN13894787. PMID:27091854

  14. Diabetic macular edema, retinopathy and age-related macular degeneration as inflammatory conditions.

    PubMed

    Das, Undurti N

    2016-10-01

    Diabetic macular edema (DME) and diabetic retinopathy (DR) are complications affecting about 25% of all patients with long-standing type 1 and type 2 diabetes mellitus and are a major cause of significant decrease in vision and quality of life. Age-related macular degeneration (AMD) is not uncommon, and diabetes mellitus affects the incidence and progression of AMD through altering hemodynamics, increasing oxidative stress, accumulating advanced glycation end products, etc. Recent studies suggest that DME, DR and AMD are inflammatory conditions characterized by a breakdown of the blood-retinal barrier, inflammatory processes and an increase in vascular permeability. Key factors that seem to have a dominant role in DME, DR and AMD are angiotensin II, prostaglandins and the vascular endothelial growth factor and a deficiency of anti-inflammatory bioactive lipids. The imbalance between pro- and anti-inflammatory eicosanoids and enhanced production of pro-angiogenic factors may initiate the onset and progression of DME, DR and AMD. This implies that bioactive lipids that possess anti-inflammatory actions and suppress the production of angiogenic factors could be employed in the prevention and management of DME, DR and AMD.

  15. Epiretinal proliferation in lamellar macular holes and full-thickness macular holes: clinical and surgical findings.

    PubMed

    Lai, Tso-Ting; Chen, San-Ni; Yang, Chung-May

    2016-04-01

    To report the clinical findings and surgical outcomes of lamellar macular holes (LMH) with or without lamellar hole-associated epiretinal proliferation (LHEP), and those of full-thickness macular holes (FTMH) presenting with LHEP. From 2009 to 2013, consecutive cases of surgically treated LMH, and all FTMH cases with LHEP were reviewed, given a follow-up time over 1 year. In the LMH group (43 cases), those with LHEP (19 cases) had significantly thinner bases and larger openings than those without (24 cases). The rate of disrupted IS/OS line was higher in the LHEP subgroup preoperatively (68.4 % vs 37.5 %), but similar between subgroups postoperatively (36.8 % and 33.3 %). The preoperative and postoperative visual acuity showed no significant difference between two subgroups. In the FTMH group (13 cases), the average hole size was 219.2 ± 92.1 μm. Permanent or transient spontaneous hole closure was noted in 69.2 % of cases. An intact IS-OS line was found in only 23 % of cases at the final follow-up. In the LMH group, LHEP was associated with a more severe defect but didn't affect surgical outcomes. In the FTMH group, spontaneous hole closure was frequently noted. Despite small holes, disruption of IS-OS line was common after hole closure.

  16. Sodium hypochlorite-induced acute kidney injury.

    PubMed

    Peck, Brandon W; Workeneh, Biruh; Kadikoy, Huseyin; Abdellatif, Abdul

    2014-03-01

    Sodium hypochlorite (bleach) is commonly used as an irrigant during dental procedures as well as a topical antiseptic agent. Although it is generally safe when applied topically, reports of accidental injection of sodium hypochlorite into tissue have been reported. Local necrosis, pain and nerve damage have been described as a result of exposure, but sodium hypo-chlorite has never been implicated as a cause of an acute kidney injury (AKI). In this report, we describe the first case of accidental sodium hypochlorite injection into the infraorbital tissue during a dental procedure that precipitated the AKI. We speculate that oxidative species induced by sodium hypochlorite caused AKI secondary to the renal tubular injury, causing mild acute tubular necrosis.

  17. Diabetic Macular Edema Pathophysiology: Vasogenic versus Inflammatory

    PubMed Central

    Baget-Bernaldiz, Marc; Pareja-Rios, Alicia; Lopez-Galvez, Maribel; Navarro-Gil, Raul; Verges, Raquel

    2016-01-01

    Diabetic macular edema (DME) can cause blindness in diabetic patients suffering from diabetic retinopathy (DR). DM parameters controls (glycemia, arterial tension, and lipids) are the gold standard for preventing DR and DME. Although the vascular endothelial growth factor (VEGF) is known to play a role in the development of DME, the pathological processes leading to the onset of this disease are highly complex and the exact sequence in which they occur is still not completely understood. Angiogenesis and inflammation have been shown to be involved in the pathogenesis of this disease. However, it still remains to be clarified whether angiogenesis following VEGF overexpression is a cause or a consequence of inflammation. This paper provides a review of the data currently available, focusing on VEGF, angiogenesis, and inflammation. Our analysis suggests that angiogenesis and inflammation act interdependently during the development of DME. Knowledge of DME etiology seems to be important in treatments with anti-VEGF or anti-inflammatory drugs. Current diagnostic techniques do not permit us to differentiate between both etiologies. In the future, diagnosing the physiopathology of each patient with DME will help us to select the most effective drug. PMID:27761468

  18. Managed care implications of diabetic macular edema.

    PubMed

    Holekamp, Nancy M

    2016-07-01

    Diabetic retinopathy (DR) is both the leading cause of blindness among adults aged 20 to 74 in the United States, and the leading ocular complication associated with diabetes mellitus (DM). An estimated 4.4% of adults with DM over 40 years of age have the more advanced form of DR: diabetic macular edema (DME), which significantly increases the risk of blindness. Medical costs for Medicare patients with DME are a third higher than for patients without DME. The majority of these costs stem from other DM-related complications, as DME is a marker for poorly controlled DM overall. Commercially insured patients with DME incur direct and indirect costs up to 75% higher than for those with DR without DME. Early detection, treatment, and improved glycemic control can limit the onset or progression of microvascular complications of DR, including DME, resulting in significant savings for payers. However, there are significant gaps in adherence to national guidelines regarding DM control and early identification of DR. In addition, patients face several barriers to screening. Improving screening for and management of early DR could decrease progression to DME, which would provide significant savings for payers, as well as improve the quality of care and outcomes for patients with DM. Managed care organizations and employers should also consider the cost-effectiveness of currently available treatments for DME: focal laser photocoagulation, vascular endothelial growth factor inhibitors, and intravitreal corticosteroid injections and implants, in their formulary design; they should also identify opportunities to improve patient adherence to treatment.

  19. New Computer Simulations of Macular Neural Functioning

    NASA Technical Reports Server (NTRS)

    Ross, Muriel D.; Doshay, D.; Linton, S.; Parnas, B.; Montgomery, K.; Chimento, T.

    1994-01-01

    We use high performance graphics workstations and supercomputers to study the functional significance of the three-dimensional (3-D) organization of gravity sensors. These sensors have a prototypic architecture foreshadowing more complex systems. Scaled-down simulations run on a Silicon Graphics workstation and scaled-up, 3-D versions run on a Cray Y-MP supercomputer. A semi-automated method of reconstruction of neural tissue from serial sections studied in a transmission electron microscope has been developed to eliminate tedious conventional photography. The reconstructions use a mesh as a step in generating a neural surface for visualization. Two meshes are required to model calyx surfaces. The meshes are connected and the resulting prisms represent the cytoplasm and the bounding membranes. A finite volume analysis method is employed to simulate voltage changes along the calyx in response to synapse activation on the calyx or on calyceal processes. The finite volume method insures that charge is conserved at the calyx-process junction. These and other models indicate that efferent processes act as voltage followers, and that the morphology of some afferent processes affects their functioning. In a final application, morphological information is symbolically represented in three dimensions in a computer. The possible functioning of the connectivities is tested using mathematical interpretations of physiological parameters taken from the literature. Symbolic, 3-D simulations are in progress to probe the functional significance of the connectivities. This research is expected to advance computer-based studies of macular functioning and of synaptic plasticity.

  20. Physics of Age Related Macular Degeneration

    NASA Astrophysics Data System (ADS)

    Family, Fereydoon

    2009-11-01

    Age-related macular degeneration (AMD) is the leading cause of blindness beyond the age of 50 years. The most common pathogenic mechanism that leads to AMD is choroidal neovascularization (CNV). CNV is produced by accumulation of residual material caused by aging of retinal pigment epithelium cells (RPE). The RPE is a phagocytic system that is essential for renewal of photoreceptors (rods and cones). With time, incompletely degraded membrane material builds up in the form of lipofuscin. Lipofuscin is made of free-radical-damaged protein and fat, which forms not only in AMD, but also Alzheimer's disease, and Parkinson's disease. The study of lipofuscin formation and growth is important, because of their association with cellular aging. In this talk I will discuss a model of non-equilibrium cluster growth that we have developed for studying the formation and growth of lipofuscin in AMD [K.I. Mazzitello, C.M. Arizmendi, Fereydoon Family, H. E. Grossniklaus, Physical Review E (2009)]. I will also present an overview of our theoretical and computational efforts in modeling some other aspects of the physics of AMD, including CNV and the breakdown of Bruch's membrane [Ongoing collaboration with Abbas Shirinifard and James A. Glazier, Biocomplexity Institute and Department of Physics, Indiana University, Y. Jiang, Los Alamos, and Hans E. Grossniklaus, Department of Ophthalmology, Emory University].

  1. Animal models of age related macular degeneration.

    PubMed

    Pennesi, Mark E; Neuringer, Martha; Courtney, Robert J

    2012-08-01

    Age related macular degeneration (AMD) is the leading cause of vision loss of those over the age of 65 in the industrialized world. The prevalence and need to develop effective treatments for AMD has lead to the development of multiple animal models. AMD is a complex and heterogeneous disease that involves the interaction of both genetic and environmental factors with the unique anatomy of the human macula. Models in mice, rats, rabbits, pigs and non-human primates have recreated many of the histological features of AMD and provided much insight into the underlying pathological mechanisms of this disease. In spite of the large number of models developed, no one model yet recapitulates all of the features of human AMD. However, these models have helped reveal the roles of chronic oxidative damage, inflammation and immune dysregulation, and lipid metabolism in the development of AMD. Models for induced choroidal neovascularization have served as the backbone for testing new therapies. This article will review the diversity of animal models that exist for AMD as well as their strengths and limitations.

  2. New Computer Simulations of Macular Neural Functioning

    NASA Technical Reports Server (NTRS)

    Ross, Muriel D.; Doshay, D.; Linton, S.; Parnas, B.; Montgomery, K.; Chimento, T.

    1994-01-01

    We use high performance graphics workstations and supercomputers to study the functional significance of the three-dimensional (3-D) organization of gravity sensors. These sensors have a prototypic architecture foreshadowing more complex systems. Scaled-down simulations run on a Silicon Graphics workstation and scaled-up, 3-D versions run on a Cray Y-MP supercomputer. A semi-automated method of reconstruction of neural tissue from serial sections studied in a transmission electron microscope has been developed to eliminate tedious conventional photography. The reconstructions use a mesh as a step in generating a neural surface for visualization. Two meshes are required to model calyx surfaces. The meshes are connected and the resulting prisms represent the cytoplasm and the bounding membranes. A finite volume analysis method is employed to simulate voltage changes along the calyx in response to synapse activation on the calyx or on calyceal processes. The finite volume method insures that charge is conserved at the calyx-process junction. These and other models indicate that efferent processes act as voltage followers, and that the morphology of some afferent processes affects their functioning. In a final application, morphological information is symbolically represented in three dimensions in a computer. The possible functioning of the connectivities is tested using mathematical interpretations of physiological parameters taken from the literature. Symbolic, 3-D simulations are in progress to probe the functional significance of the connectivities. This research is expected to advance computer-based studies of macular functioning and of synaptic plasticity.

  3. Statistical physics of age related macular degeneration

    NASA Astrophysics Data System (ADS)

    Family, Fereydoon; Mazzitello, K. I.; Arizmendi, C. M.; Grossniklaus, H. E.

    Age-related macular degeneration (AMD) is the leading cause of blindness beyond the age of 50 years. The most common pathogenic mechanism that leads to AMD is choroidal neovascularization (CNV). CNV is produced by accumulation of residual material caused by aging of retinal pigment epithelium cells (RPE). The RPE is a phagocytic system that is essential for renewal of photoreceptors (rods and cones). With time, incompletely degraded membrane material builds up in the form of lipofuscin. Lipofuscin is made of free-radical-damaged protein and fat, which forms not only in AMD, but also Alzheimer disease and Parkinson disease. The study of lipofuscin formation and growth is important, because of their association with cellular aging. We introduce a model of non-equilibrium cluster growth and aggregation that we have developed for studying the formation and growth of lipofuscin in the aging RPE. Our results agree with a linear growth of the number of lipofuscin granules with age. We apply the dynamic scaling approach to our model and find excellent data collapse for the cluster size distribution. An unusual feature of our model is that while small particles are removed from the RPE the larger ones become fixed and grow by aggregation.

  4. Animal models of age related macular degeneration

    PubMed Central

    Pennesi, Mark E.; Neuringer, Martha; Courtney, Robert J.

    2013-01-01

    Age related macular degeneration (AMD) is the leading cause of vision loss of those over the age of 65 in the industrialized world. The prevalence and need to develop effective treatments for AMD has lead to the development of multiple animal models. AMD is a complex and heterogeneous disease that involves the interaction of both genetic and environmental factors with the unique anatomy of the human macula. Models in mice, rats, rabbits, pigs and non-human primates have recreated many of the histological features of AMD and provided much insight into the underlying pathological mechanisms of this disease. In spite of the large number of models developed, no one model yet recapitulates all of the features of human AMD. However, these models have helped reveal the roles of chronic oxidative damage, inflammation and immune dysregulation, and lipid metabolism in the development of AMD. Models for induced choroidal neovascularization have served as the backbone for testing new therapies. This article will review the diversity of animal models that exist for AMD as well as their strengths and limitations. PMID:22705444

  5. Macular pigment assessment by motion photometry.

    PubMed

    Moreland, J D

    2004-10-15

    A Moreland anomaloscope was modified to measure macular pigment optical density (MPOD) profiles by motion photometry. A grating (spatial frequency 0.38 c deg(-1)), whose alternate bars were filled, respectively, with 460 nm (maximum MP absorption) and 580 nm (zero MP absorption) lights, drifted steadily at 37 degrees s(-1). The subject adjusted the 580 nm radiance to minimise perceived motion (equiluminance between 460 and 580 nm). Five or more settings were made for two foveal fields (0.9 degrees and 2.2 degrees diameter) and 11 extrafoveal annular fields (0.8 degrees -7.5 degrees eccentricity). Twenty subjects made measurements for both eyes: some with replications. MPOD profiles varied in scale (0.18-0.75 for the 0.9 degrees foveal field) and in shape. A mean profile was derived. Foveal data were optimally aligned with annular data in that profile when plotted at 0.71 of the foveal field radius. Factors that limit precision were identified, such as fixation errors foveally and Troxler's effect parafoveally.

  6. Spontaneous Closure of a Full-Thickness Macular Hole Associated with Proliferative Diabetic Retinopathy and Persistent Vitreomacular Traction

    PubMed Central

    Reinherz, Benjamin J.; Rubin, Jeffrey S.

    2016-01-01

    Diabetic retinopathy worsens the prognosis of macular holes compared to those of idiopathic etiology. While spontaneous closure of idiopathic macular holes is a well-documented phenomenon, spontaneous closure of macular holes associated with proliferative diabetic retinopathy is rare. We report a case of spontaneous closure of a macular hole associated with proliferative diabetic retinopathy and persistent vitreomacular traction. PMID:27099607

  7. The review of autopsy cases of accidental childhood deaths in Istanbul.

    PubMed

    Yayci, Nesime; Pakis, Isil; Karapirli, Mustafa; Celik, Sefa; Uysal, Cem; Polat, Oguz

    2011-08-01

    Children are at increased risk for various causes of injury from accidents. Accidents are, by far, the leading cause of death among children and adolescents. The aim of this study is to evaluate the lethal childhood accidents in İstanbul by age groups. Reports of autopsies performed between 2001 and 2005 in the Morgue Department of the Council of Forensic. Medicine in Istanbul (n :16853) are examined retrospectively. 833 deaths from accidents in children aged 0-18 years are investigated into the study. The parameters of age, gender, types of accidents and causes of death are evaluated. The accidents account for 47.3% of the deaths among children aged 0-18 years. Of 833 cases, 601 (73%) are male and 232 (27%) are female. The female to male ratio is 1/2.6. The highest rate of death from accidents is at the group of 15-18 years. The primary causes of accidental childhood deaths are motor vehicle accidents (23.1%), followed by drowning (20,1%), poisoning (15.7%), and fall from height (15.5%). The incidence and types of trauma vary with socio-economic status and culture. İstanbul, where this study is conducted in, has approximately 3000 autopsy number annually. Therefore, it provides an important database. Copyright © 2011 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

  8. Accidental exposure to UV radiation produced by germicidal lamp: case report and risk assessment.

    PubMed

    Zaffina, Salvatore; Camisa, Vincenzo; Lembo, Marco; Vinci, Maria Rosaria; Tucci, Mario Graziano; Borra, Massimo; Napolitano, Antonio; Cannatà, Vittorio

    2012-01-01

    Ultraviolet radiation is known to cause both benefits and harmful effects on humans. The adverse effects mainly involve two target organs, skin and eye, and can be further divided into short- and long-term effects. The present case report describes an accidental exposure of two health-care workers to ultraviolet radiation produced by a germicidal lamp in a hospital pharmacy. The germicidal lamp presented a spectrum with an intense UV-C component as well as a modest UV-B contribution. Overexposure to UV-C radiation was over 100 times as large as the ICNIRP exposure limits. A few hours after the exposure, the two subjects reported symptoms of acute UV injury and both of them continued having significant clinical signs for over 2 years. In this study, we describe acute and potentially irreversible effects caused by high UV exposure. In addition, we present the results of risk assessment by occupational exposure to germicidal lamps. © 2012 Wiley Periodicals, Inc. Photochemistry and Photobiology © 2012 The American Society of Photobiology.

  9. Stray bullet: An accidental killer during riot control

    PubMed Central

    Wani, Abrar A.; Ramzan, Altaf U.; Shoib, Yawar; Malik, Nayil K.; Nizami, Furqan A.; Dhar, Anil; Alam, Shafiq

    2011-01-01

    Background: The use of force to control public uprisings, riots, unruly mobs is an important tool in any administrative setup. Law enforcement agencies often resort to aerial firing, which can be responsible for unintended injuries due to stray bullets.This study was designed to study the pattern of stray bullet injuries and to generate awareness about the hazards related to the use of live ammunition during riot control. Methods: This study was conducted in our unit of the neurosurgery department over a period of 18 months, from June 2008 to December 2010. We enrolled all patients who had head or spine injuries caused by stray bullets from firing during riot control far away from the site of injury. Results: We had two patients with head injury and two with spinal injury sustained because of stray bullets. One of the patients with head injury was operated and the other one was managed conservatively; the latter died on the third day of injury, while the former is surviving with some residual neurological deficit. Amongst the patients with spinal injury, neurological deficits persist till date. None of the patients were aware that they had sustained a bullet injury, and it was only after inquiry that we came to know that the police had resorted to aerial firing for controlling public agitation in nearby areas. Conclusion: Aerial firing of live cartridges is generally considered an ‘innocuous’ method; however, in view of the potential for injury to innocent bystanders, we recommend that the use of live cartridges during aerial firing be banned. PMID:22022659

  10. EVALUATION OF SHORT-TERM OUTCOMES OF INTRAVITREAL AFLIBERCEPT INJECTIONS FOR AGE-RELATED MACULAR DEGENERATION USING FOCAL MACULAR ELECTRORETINOGRAPHY.

    PubMed

    Takayama, Kei; Kaneko, Hiroki; Ueno, Shinji; Maruko, Ruka; Piao, Chang-Hua; Yasuda, Shunsuke; Kawano, Kenichi; Ito, Yasuki; Terasaki, Hiroko

    2017-03-01

    To evaluate the relationship between morphological changes and functional improvements assessed using focal macular electroretinograms after intravitreal aflibercept (IVA) injections in eyes with wet age-related macular degeneration. The clinical records of 42 eyes of 42 consecutive patients with naive, wet age-related macular degeneration received 3 monthly IVA were reviewed. The best-corrected visual acuity, central foveal thickness, outer retinal thickness, inner retinal thickness at baseline and 1 month after each IVA, and focal macular electroretinograms at baseline and 1 month after the first and third IVA were compared. Best-corrected visual acuity was improved after the third IVA (P = 0.0091). Central foveal thickness and outer retinal thickness showed decreases after every IVA (P < 0.001, respectively). Inner retinal thickness showed a decrease after the second IVA (P = 0.002), after and third IVA (P = 0.001). On focal macular electroretinograms, a- and b-wave amplitudes showed increases after the third IVA (P = 0.0028, P = 0.0012, respectively). Significant correlations were observed between best-corrected visual acuity and central foveal thickness, a-wave amplitude and outer retinal thickness, and b-wave amplitude and inner retinal thickness changes after the third IVA. All parameters significantly recovered after three monthly IVA, with a correlation between functional improvements and morphological changes.

  11. Juvenile-Onset Macular Degeneration and Allied Disorders

    PubMed Central

    North, Victoria; Gelman, Rony; Tsang, Stephen H.

    2015-01-01

    While age-related macular degeneration (AMD) is a leading cause of central vision loss among the elderly, many inherited diseases that present earlier in life share features of AMD. These diseases of juvenile-onset macular degeneration include Stargardt disease, Best disease, retinitis pigmentosa, X-linked retinoschisis, and other allied disorders. In particular, they can be accompanied by the appearance of drusen, geographic atrophy, macular hyperpigmentation, choroidal neovascularization, and disciform scarring just as in AMD, and often may be confused for the adult form of the disease. Diagnosis based on funduscopic findings alone can be challenging. However, the use of diagnostic studies such as electroretinography, electrooculography, optical coherence tomography, and fundus autofluorescence in conjunction with genetic testing can lead to an accurate diagnosis. PMID:24732760

  12. Macular and serum carotenoid concentrations in patients with malabsorption syndromes.

    PubMed

    Ward, Matthew S; Zhao, Da You; Bernstein, Paul S

    2008-03-01

    The carotenoids lutein and zeaxanthin are believed to protect the human macula by absorbing blue light and quenching free radicals. Intestinal malabsorption syndromes such as celiac and Crohn's disease are known to cause deficiencies of lipid-soluble nutrients. We hypothesized that subjects with nutrient malabsorption syndromes will demonstrate lower carotenoid levels in the macula and blood, and that these lower levels may correlate with early-onset maculopathy. Resonance Raman spectrographic (RRS) measurements of macular carotenoid levels were collected from subjects with and without a history of malabsorption syndromes. Carotenoids were extracted from serum and analyzed by high performance liquid chromatography (HPLC). Subjects with malabsorption (n = 22) had 37% lower levels of macular carotenoids on average versus controls (n = 25, P < 0.001). Malabsorption was not associated with decreased serum carotenoid levels. Convincing signs of early maculopathy were not observed. We conclude that intestinal malabsorption results in lower macular carotenoid levels.

  13. [Literature review: Diabetic macular edema. Repercussions and treatment].

    PubMed

    Carmona-Moxica, Luis Roberto; Hernández-Núñez, Fabiola

    2015-01-01

    In our country there is a report of prevalence of Diabetes Mellitus in the adult population of a 10%, occupying one of the first causes of morbidity-mortality, also visual and labor incapacity. Macular edema is the first cause of lost vision in the diabetic patient. There are classic methods to detect it, as the examination with biomicroscope, indirect ophthalmoscopy, fluorangiography (FAR), and the new and gold standard method for diagnostic and sequence examination, Ocular Coherence Tomography (OCT). With OCT had been possible the study of distinct types of macular edema, that could represent distinct clinical states, with specific treatments. The protocol of treatment of macular edema, continues changing. The traditional methods as metabolic control and fotocoagulation with Laser now have more options as intravitreal injection of triamcinolone, or antiangiogenic substances, even surgical treatment with vitrectomy. There are many prospective and randomized studies evaluating this methods, so until now is difficult to determine which treatment is the best.

  14. Developments in age-related macular degeneration: Diagnosis and treatment.

    PubMed

    Kaufman, Steven R

    2009-03-01

    Age-related macular degeneration (ARMD) is the leading cause of legal blindness of Americans over age 65 years. Severe loss of vision is usually due to exudative ARMD, of which there are about 200,000 new cases in the United States annually. Until recently, only a small fraction of patients benefited from treatment, but advances in the early diagnosis of the disease and major developments in therapy have substantially improved the prognosis of patients with ARMD. Because visual loss substantially reduces quality of life, effective management of ARMD will have increasing public health importance as the population ages. The American Academy of Ophthalmology recommends that people over age 65 years should have a comprehensive eye examination every 1 to 2 years to check for cataracts, macular degeneration, glaucoma, and other conditions. Those who complain of difficulty reading, driving at night, or adapting from sunlight to indoor lighting might have macular degeneration.

  15. Age-related macular degeneration: current treatment and future options.

    PubMed

    Moutray, Tanya; Chakravarthy, Usha

    2011-09-01

    Age-related macular degeneration is the leading cause of visual impairment among older adults in the developed world. Epidemiological studies have revealed a number of genetic, ocular and environmental risk factors for this condition, which can be addressed by disease reduction strategies. We discuss the various treatment options for dry and exudative age-related macular degeneration available and explain how the recommended treatment depends on the exact type, location and extent of the degeneration. Currently, vascular endothelial growth factor (VEGF) inhibition therapy is the best available treatment for exudative age-related macular degeneration but is limited by the need for repeated intravitreal injections. The current treatment regime is being refined through research on optimal treatment frequency and duration and type of anti-VEGF drug. Different modes of drug delivery are being developed and in the future other methods of VEGF inhibition may be used.

  16. Bimatoprost Induced Serous Macular Detachment after Cataract Surgery

    PubMed Central

    Kaliaperumal, Subashini; Deb, Amit Kumar; Babu, K. Ramesh; Srinivasan, Renuka

    2016-01-01

    We report a case of bimatoprost induced serous macular detachment and choroidal folds following uneventful cataract surgery. A 66-year-old male using topical bimatoprost in both eyes for open angle glaucoma underwent uneventful cataract surgery in the right eye. Postoperatively, he was restarted on topical bimatoprost and antibiotic-steroids combination drops. One week after surgery, he presented with conjunctival hyperemia, serous macular detachment, and choroidal folds at the posterior pole. Fundus fluorescein angiography showed perifoveal leaks in early stage with pooling of dye in late stage. Discontinuation of bimatoprost led to resolution of serous detachment and choroidal folds within 3 weeks with significant improvement in visual acuity. Occurrence of serous macular detachment and choroidal folds in this case could be probably related to the proinflammatory property of bimatoprost. Hence, it should be used with caution in the immediate postoperative period after cataract surgery. PMID:27957367

  17. Bilateral choroidal excavation in best vitelliform macular dystrophy.

    PubMed

    Parodi, Maurizio Battaglia; Zucchiatti, Ilaria; Fasce, Francesco; Bandello, Francesco

    2014-02-14

    Focal choroidal excavation (FCE) has recently been described as one or more localized areas of choroidal excavation on spectral-domain optical coherence tomography (SD-OCT). The authors describe a case of bilateral FCE in Best vitelliform macular dystrophy (VMD). SD-OCT revealed FCE in both eyes characterized by interruption of the internal segment-outer segment junction and the presence of subretinal hyporeflective space. This is the first report describing bilateral FCE in a distinct macular disorder and specifically with VMD. Future investigations are warranted to ascertain the involvement of other macular dystrophies with atrophic evolution and the impact of FCE on the clinical course. [Ophthalmic Surg Lasers Imaging Retina. 2014;45:e8-e10.].

  18. [Macular threshold after ECCE and posterior chamber IOL implantation].

    PubMed

    Baltatzis, S; Georgopoulos, G; Andreanos, D

    1989-01-01

    In the present paper, the macular threshold after ECCE and posterior chamber intraocular lens implantation, was studied in an effort to determine the time period needed for full postoperative recovery of macular function. We evaluated 22 eyes in 20 patients who underwent extracapsular cataract extraction and posterior chamber IOL implantation. There were 12 men and 8 women between the ages of 40 and 62 years with mean age of 53 years. Postoperative visual field testing was performed within the central 4 degrees with an automated static perimeter (Humphrey Visual Field Analyser), using a macular threshold test pattern. It has been established that central retinal sensitivity in pseudophakia shows a postoperative decrease and consequently recovers to almost normal levels within one month. The exact cause of this reduction remains under discussion and further control mainly with fluorescein angiography is necessary.

  19. Macular pigmentation of uncertain aetiology revisited: two case reports and a proposed algorithm for clinical classification.

    PubMed

    Chandran, Veena; Kumarasinghe, Sujith Prasad

    2017-02-01

    Ashy dermatosis, erythema dyschromicum perstans, lichen planus pigmentosus and idiopathic eruptive macular pigmentation are various types of acquired macular hyperpigmentation disorders of the skin described in literature. However, a global consensus on the definitions of these entities is lacking. We report two cases of acquired macular (hyper)pigmentation of uncertain aetiology diagnosed as ashy dermatosis and attempt to clarify the various confusing nosologies based on existing literature. We infer that acquired small and large macular pigmentation of uncertain aetiology should be considered separate from that associated with lichen planus. We also propose a diagnostic algorithm for patients with acquired macular hyperpigmentation.

  20. Macular hard exudates and scar formation after laser photocoagulation in retinopathy of prematurity.

    PubMed

    Epstein, Ilan J; Aziz, Hassan A; Young, Ryan C; Berrocal, Audina M

    2013-07-02

    The authors report the formation of hard exudates and macular scarring after laser photocoagulation therapy in patients with retinopathy of prematurity (ROP). Two premature neonates, the first born at 24 weeks and the second at 25 weeks gestational age, were diagnosed as having ROP that necessitated laser photocoagulation treatment at 32 and 36 weeks, respectively. Subretinal fluid and macular hard exudation developed in both patients that eventually caused bilateral macular scarring. Subretinal macular fluid with hard exudation could lead to macular scar formation in neonates with ROP after laser photocoagulation that could significantly affect the visual prognosis in preterm infants. Copyright 2013, SLACK Incorporated.