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Biomedical subjects

A M Fink

Publications and source records attributed to A M Fink.

At least 19 recordsLinked to original sources
PubMed2002

Lupus anticoagulant and venous leg ulceration.

BACKGROUND: Most leg ulcers occur in patients with venous insufficiency. However, not all patients with venous insufficiency develop leg ulcers. Recent studies have found that factors causing clotting abnormalities, e.g. anticardiolipin antibody (ACA), are associated with leg ulcers. Although lupus anticoagulant, like ACA, belongs to the group of antiphospholipid antibodies, its presence in patients with venous leg ulceration has not been previously reported. OBJECTIVES: To determine the presence of lupus anticoagulant in patients with venous leg ulceration. METHODS: We investigated the presence of lupus anticoagulant in 27 patients with venous leg ulcers and compared these data with controls. Lupus anticoagulant was evaluated in all subjects by the Russell's viper venom test. RESULTS: Of 27 patients with venous leg ulceration, 16 (59%) were shown to have lupus anticoagulant, while only one of 32 controls (3%) was found to have lupus anticoagulant. Thus, lupus anticoagulant was significantly more frequent in patients with venous leg ulcers than in controls (P < 0.001). CONCLUSIONS: We suggest that lupus anticoagulant could be a hitherto unknown factor contributing to the development of venous leg ulcers.

Aged↗
PubMed2001

[Mondor phlebitis associated with hepatitis C].

Mondor's disease in association with hepatitis C. We report a case of a 40 years old patient suffering from Mondor's disease. Neither a malignancy nor a disturbance of the clotting system was found. This case is remarkable for the association with hepatitis C.

Adult↗
PubMed2001

Delayed presentation of an ingested foreign body causing gastric perforation.

Ingested foreign bodies may lead to perforation of the gastrointestinal tract. We present a case of a 14-month-old boy who presented with an unusual abdominal mass secondary to ingesting a foreign body 4 months previously. Abdominal computerized tomography scan was valuable in making this diagnosis.

Foreign Bodies↗
PubMed2001

Seasonal pattern of the excision rate of melanoma and naevi.

Based on available information that melanocytic skin lesions presenting a junctional component are more susceptible to the influence of ultraviolet radiation, this study compares the seasonal differences between the excision rates of melanocytic skin lesions with a junctional component to those without. The histological diagnoses of 1230 patients with melanocytic skin lesions were retrospectively analysed. Depending on the histological diagnosis four groups were formed: melanomas, dysplastic naevi, common naevi (junctional and compound naevi), and dermal naevi. All dates of operations were allocated to summer or winter halves of the year. The collected data were computer analysed for statistical description. The number of excisions of melanocytic lesions with a junctional component (melanoma, dysplastic naevi, common naevi) showed an impressive seasonal variation, with a peak during the summer months, while the excision frequency of dermal naevi was approximately constant during the year. In conclusion, we suggest that ultraviolet radiation may contribute to the seasonal pattern of excision of melanoma and naevi only when a junctional component is present.

Age Factors↗
PubMed2000

Refractive lensectomy for hyperopia.

PURPOSE: The purpose of this study was to evaluate refractive lensectomy as a surgical procedure for the treatment of hyperopia. DESIGN: A retrospective noncomparative case series. PARTICIPANTS: Twenty-nine patients were included in the study. Fifty eyes underwent extraction of the crystalline lens and intraocular lens implantation. METHODS: Operations were performed by the same surgeon with the patient under general anesthetic. All lenses were removed by phacoemulsification with insertion of lens implants singly or as piggyback lenses. The Holladay2 formula was used to calculate lens powers. Results are compared with other methods of treating hyperopia. MAIN OUTCOME MEASURES: The main parameters assessed were safety, efficacy, predictability, stability, and complications. RESULTS: Eyes were divided into group A (n = 26), with an average preoperative spherical equivalent (SE) of +2.26 +/- 0.94, and group B (n = 24), with an average preoperative SE of +6.32 +/- 1.32. In group A, after refractive lensectomy, 80.7% had no change in best-corrected visual acuity (BCVA) or gained a line, whereas 11.5% lost one line; 88.5% had an uncorrected visual acuity (UCVA) of 20/40 or better, and 88.5% were within 1 diopter (D) of intended postoperative SE. In group B, 70.9% of eyes had no change or gained a line in BCVA, whereas 29.2% lost a line of BCVA; 62.5% had UCVA of 20/40 or better postoperatively, and 58.3% were within 1 D of the intended SE. In one eye the posterior capsule was breached intraoperatively. One eye had a symptomatic episode of cystoid macula edema that settled spontaneously. To date, seven eyes have required secondary refractive procedures, and three eyes have required yttrium-aluminum-garnet capsulotomy. CONCLUSIONS: In the presbyopic age group refractive lensectomy may be a realistic alternative to photorefractive keratectomy or laser in situ keratomileusis, with certain potential advantages.

Female↗
PubMed1999

Cataract development after implantation of the Staar Collamer posterior chamber phakic lens.

Implantation of a posterior chamber phakic intraocular lens is an effective refractive procedure with a good safety record in the short-term follow-ups reported in the literature. Cataract formation is a potential complication of the procedure. Two patients developed lens opacities in 3 eyes after the procedure was performed for myopic astigmatism. The possible causes are discussed. This is not a dangerous complication as cataract extraction is easily achieved if necessary. However, it is undesirable and further research is required to assess the long-term incidence, causes, and ways to prevent its occurrence.

Adult↗
PubMed1998

B mode ultrasonography--spectrum of paediatric ocular disease.

BACKGROUND: Despite having appropriate sonographic equipment available many radiologists remain unfamiliar with B mode sonography of the eye. OBJECTIVE: This article reviews the advantages and disadvantages of B mode sonography of the paediatric eye. We illustrate the spectrum of eye abnormalities occurring in paediatric practice and the sonographic appearance of clinical entities for which sonography is appropriate. MATERIALS AND METHOD: We reviewed our experience of eye sonography within a paediatric radiology department over 8 years. A total of 212 sonographic examinations were performed on 206 eyes in 103 children, aged from 3 days to 16 years (mean 4.6 years). RESULTS: Sonography was well tolerated by the children, was a very useful imaging modality and was the only diagnostic imaging modality required in 94%. Supplementary computed tomography (CT) was performed in ten of 206 eyes (5%) and magnetic resonance imaging (MR) was performed in two of 206 eyes (1%). CONCLUSIONS: B mode sonography is a very useful imaging modality for suspected ocular or orbital pathology in children and is often the appropriate first line investigation following clinical evaluation. Radiologists familiar with sonography of the eye can provide valuable support to their ophthalmology colleagues.

Adolescent↗
PubMed1998

Totally implantable venous access devices in children with cystic fibrosis: incidence and type of complications.

BACKGROUND: Totally implantable vascular access devices (TIVADs) are accepted as a safe and effective method of facilitating long term intravenous therapy. We report our experience of the use of these devices in children with cystic fibrosis with a particular focus on the incidence and type of complications. METHODS: The medical records of patients with cystic fibrosis who underwent placement of a TIVAD at the Royal Children's Hospital, Melbourne, Australia from January 1987 to October 1996 were reviewed. Venous ultrasonography with Doppler was performed in surviving patients with a TIVAD in situ from November 1996 to April 1997 to detect occult thrombotic complications. RESULTS: A total of 57 TIVADs were implanted in 44 children with a median functional duration of 700 days (range 27-3347 days). Twenty one children had devices inserted without complications. Forty eight complications (30 mechanical, 18 infectious) occurred in 36 devices in 23 children during a total functional duration of 53,057 catheter days. Mechanical complications occurred in 53% of devices (one per 1712 catheter days). Symptomatic venous thrombosis occurred five times in four patients (9%). Infectious complications occurred in 32% (one per 2948 catheter days) while sepsis occurred in five devices (9%). Doppler ultrasonography detected unsuspected thrombosis in two of 10 patients examined. CONCLUSIONS: While TIVADs provided effective long term intravenous access, septic and thrombotic complications caused significant morbidity in this population. Careful patient selection, adherence to aseptic technique for access and blood sampling, and periodic ultrasonography with Doppler to detect early thrombosis may help reduce these risks.

Adolescent↗
PubMed1997

Wall enhancement of leaking polytetrafluoroethylene grafts: a new CT sign.

Perigraft seroma is a rare complication of synthetic vascular grafts. We describe a new sign observed in two children who underwent computed tomography of the chest for further evaluation of seromas complicating modified Blalock-Taussig procedures in which a polytetrafluoroethylene graft was used. In both patients contrast enhancement of the wall of the leaking graft was demonstrated on delayed imaging. One patient had bilateral grafts, and the enhancement was only demonstrated in the wall of the leaking graft. We discuss the possible mechanism of this finding and propose that this sign may be further evidence of abnormal graft permeability.

Blood Vessel Prosthesis↗
PubMed1996

A follow-up study of the learning transfer process in further training of nursing staff.

The purpose of the study was to investigate whether the human and economic investment of resources in the further training of nursing and nursing assistants is justified. The study focused in particular on the transfer of knowledge from training course to working practice. It was carried out as a case study in Ringkøbing County, Denmark, during 1993/94. The population consisted of 49 nurses and 49 nursing assistants. The study showed that the participants took a keen interest in the courses. The learning process was found relevant by the nurses, but not by the nursing assistants. Neither group found that their expectations of getting more knowledge were satisfied. With respect to job-behaviour, the study confirmed the hypothesis that the practising of the content of the course will depend on the support and interest of the head of the department towards a goal-oriented development of competence and structure. If such support and interest is lacking, the course-participant will only change her own working practices, independent of the organizational structure.

Adult↗
PubMed1995

Buscopan and glaucoma: a survey of current practice.

UNLABELLED: Hyoscine butylbromide (Buscopan) is commonly used by radiologists in the UK as a hypotonic agent in double-contract gastrointestinal studies. A history of glaucoma is still taught to be the prime contraindication to its use, although the only individuals at risk are those with undiagnosed and therefore untreated angle closure glaucoma (ACG), who will not give a positive history. We conducted a postal survey of all members and fellows of the Royal College of Radiologists in the UK to establish current practice. RESULTS: Of the 1045 respondents who use Buscopan, 724 (81.6%) withhold it if the patient gives a history of glaucoma, and 631 (87.2%) of this group substitute glucagon. Of the 51 respondents who state that they understand that the patient who gives the positive history is not the one at risk, 22 continue to withhold Buscopan because of the established teaching. Only 429 (52.4%) substitute glucagon for Buscopan if the patient gives a history of heart disease. Eight respondents (0.8%) have seen an attack of glaucoma thought to have been precipitated by Buscopan, and 20 (1.9%) have seen cardiac complications. CONCLUSION: There are still widespread misconceptions about the contraindications to the use of Buscopan among radiologists in the UK. We recommend abandoning the practice of enquiring about a history of glaucoma, and substituting advice to seek urgent medical advice should eye pain and visual loss develop. Caution in the patient with heart disease appears to be of greater importance.

Algorithms↗