Biomedical subjects
A H Paul
Publications and source records attributed to A H Paul.
Vitreofoveal traction syndrome in the young.
Young patients with sub-optimal visual acuity and no obvious ophthalmic pathology were found to complain of a 'shadow' or decreased brightness, with no metamorphopsia, at the point of regard, suggesting a pathology anterior to the neuroepithelium of the retina. Examination of fourteen such patients with a fundus contact lens revealed a focal vitreo-foveal detachment in eleven patients. Nine patients had a white plaque attached to this detachment, with a corresponding visible loss of superficial retinal tissue in one case. One patient had minute lamellar holes bilaterally. We feel that tenuous attachments of the vitreous body to the fovea could exert traction on the vitreo-retinal interface or shrinkage of a fibrocellular membrane on the inner foveal surface could lead to the observations made by us. The diagnosis of such lesions could be used to determine the cause of a sudden loss of vision in young patients, preventing the needless use of expensive and invasive investigations.
Maternal drug histories and congenital malformations: limb reduction defects and oral clefts.
In a case control study, prescription data were examined for the three months before the last menstrual period and for the first trimester of pregnancy in (a) 115 mothers of children with limb reduction defects, (b) 676 mothers of children with oral cleft, and (c) an equal number of control mothers of normal babies from the same doctor's practice for each case. In the limb reduction study, the study mothers were prescribed more drugs generally although this did not reach statistical significance, nor were there significant differences between study and control mothers for individual groups of drugs. In the oral cleft study, significantly more drugs were prescribed to study mothers in the three months before the last menstrual period, and a similar trend, which did not reach statistical significance, was observed in the first trimester. Anticonvulsant drugs were prescribed significantly more frequently to study mothers during the whole period of the study. A significant association was also demonstrated between oral contraceptives taken in the three months before the last menstrual period and oral cleft, but doubt must remain concerning this relationship; the risk is not well understood and is likely to be nonspecific. A number of other significant associations were identified, although their importance in practice is uncertain in view of the confounding factors that may affect a study of this kind.
Mercury: understanding increases safety.
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The general practitioner and drug dependence.
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Chemical food poisoning by potassium bromate. Report of an outbreak.
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The neonatal fundus in maternal toxemia.
Toxemic changes in the maternal fundus and their relationship to fetal prognosis have been studied. A study of the neonatal fundus in maternal toxemia revealed a 76.67% incidence of vascular changes similar to those seen in the maternal fundus. Arteriolar spasm, focal or generalized, was present in 23 of the 30 neonates seen. A pallor of the disc was present in six cases. Four infants, 13.33%, had either extensive dot and blot retinal hemorrhages with soft exudates, or a serous retinal detachment. The last four neonates died within the first postnatal week. This work highlights the fact that retinal vascular decompensation mirrors similar changes in the cardiopulmonary or cerebral circulation and should be considered as a determinant of the fetal prognosis in maternal toxemia.
The neonatal fundus in maternal toxemia.
Fetal mortality appears to be related to the neonatal fundus findings of a generalized arteriolar spasm, together with either a serous retinal detachment or the presence of numerous superficial and deep retinal hemorrhages with "cotton wool" spots. The excellent management of maternal blood pressure does not allow changes to occur in the maternal fundus; thus, the existence of adverse factors to the fetus/newborn cannot be determined by an examination of the maternal fundus. The fundus examination of a neonate at risk is likely to be very helpful in identifying those babies who would require intensive monitoring and care, resulting in an infant mortality rate far lower than the current rate.