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Biomedical subjects

D B Schaffer

Publications and source records attributed to D B Schaffer.

At least 37 records · Page 2Linked to original sources

A revised classification of retinopathy of prematurity.

We have developed a classification system for the acute phases of retinopathy of prematurity based on more than 13,000 ophthalmoscopic examinations of more than 3,400 premature infants between 1968 and 1982. Two forms of the active disease exist. Retinopathy of prematurity is a relatively common mild disease and retinopathy of prematurity plus is characterized by rapid progression and posterior pole vascular tortuosity and dilation. The five grades progress from peripheral vascular abnormalities (Grade 1) through a demarcation line (Grade 2) and extraretinal neovascularization (Grade 3) to partial (Grade 4) or total (Grade 5) retinal detachment. The persistence of abnormal retinal vessels during the first year of life is considered "transitional" retinopathy of prematurity unless unequivocal cicatricial changes with macular distortion develop.

Humans↗

Retrolental fibroplasia and blood transfusion in very low-birth-weight infants.

The relative contribution of transfusions of adult blood to the development of retrolental fibroplasia (RLF) in very low-birth-weight infants was examined. Five years of experience with the expanded use of replacement and exchange transfusions in 90 infants with birth weight less than or equal to 1,250 gm was reviewed. Twenty percent of the infants developed cicatricial RLF. Exchange transfusion was not related to development of cicatricial RLF. The incidence of RLF in infants receiving greater or equal to 130 ml of packed red blood cells per kilogram of birth weight as replacement blood transfusion (RBT) was significantly higher (42.9%) than that in infants receiving 61 to 131 ml of packed red blood cells per kilogram (15.4%) and infants receiving less than or equal to 60 ml of packed red blood cells per kilogram (0%), P less than .001. The need for RBT, however, was strongly correlated (r = .85, P less than .001) with increasing duration of O2 therapy. When O2 therapy was controlled for, the association between RBT and RLF did not achieve statistical significance (P = .07). The association between RBT and RLF remained significant when adjusted for duration of therapy in fractional inspired oxygen (FIO2) greater than 0.4. Further detailed studies of large numbers of susceptible infants are warranted to assess the magnitude of the contribution of transfusions of adult blood to development of RLF.

Exchange Transfusion, Whole Blood↗

Ocular alignment after craniofacial reconstruction.

We undertook a retrospective study of 160 patients to ascertain if craniofacial reconstruction affected ocular alignment. In most patientspre-existing alignment and binocularity were unaffected by craniofacial surgery; thus, correction of any strabismus can be performed on a child without concern for disruption of muscle tissue by later craniofacial surgery.

Adolescent↗

Variations in extraocular muscle number and structure in craniofacial dysostosis.

Five of 12 patients with craniofacial dysostosis who needed strabismus surgery had anomalies of extraocular muscle structure and number. Two cul-de-sac incisions per eye are sufficient to investigate all muscles for anomalies and add little time or risk to the planned strabismus procedure. The origin of these anomalies and their frequency in craniofacial stenosis are unknown.

Adolescent↗

A classification of retrolental fibroplasia to evaluate vitamin E therapy.

A refined classification of the stages of the retinopathy of prematurity (RLF) based on the experience of over 7500 examinations during the past decade is presented. We have been using the basic elements of this classification since 1972 in order to evaluate the influence of vitamin E on retrolental fibroplasia (RLF). It is our impression that it provides a more accurate clinical method of following the course of the retinopathy and a tool for assessing the factors other than prematurity and hyperoxia that may play a subtle role in the development of RLF.

Humans↗

Intrascleral nerve loop mistakenly identified as a foreign body.

A 5-year-old boy had an excisional biopsy of a pigmented scleral lesion thought clinically to be a foreign body, probably graphite from a pencil. Histological study demonstrated that the pigmented lesion was an intrascleral nerve loop (Axenfeld).

Child, Preschool↗

Severe traumatic oculo-orbital displacement. Diagnosis and secondary treatment.

We have treated 12 patients with severe oculo-orbital trauma during the past 3 years. The structural problems, produced by disruption or displacement of the orbital cone, were treated effectively (and, on occasion, preferentially) with onlay bone grafts. For an effective correction, we advise radical mobilization of the soft tissue and simultaneous correction on the ocular adnexal deformities. Ocular muscle problems are produced by direct injury to the extraocular muscles, or oculomotor nerve, and were possible these should be corrected early. The structural damage to the eye and orbit falls into certain patterns, related to weak points about the orbit. These have been described.

Adult↗

Kansas Regional Medical Program Library Services.

The Kansas Regional Medical Program Office for Library Services was developed to link the medical library resources and to make them available to health-related personnel throughout Kansas. Library offices have been established at the Central Kansas Medical Center, Great Bend, Stormont Medical Library, Topeka, and at the Wichita State University, Wichita. The main office, located at the Clendening Medical Library, University of Kansas Medical Center, Kansas City, provides medical library services to those three offices, the other medical libraries in Kansas, and to the health professionals in the state who do not have medical library resources available. Reference requests are accepted via a twenty-four-hour telephone service from medical librarians and from individual health professionals.

Communication↗

Infantile glaucoma associated with the Diamond-Blackfan syndrome.

Diamond-Blackfan syndrome is a rare congenital hematologic disorder characterized by isolated erythroid hypoplasia. Physical abnormalities such as short stature, thumb deformities, and ophthalmic findings including strabismus, hypertelorism, and microphthalmos have been reported to occur with this disease entity. We describe two patients with this blood dyscrasia and infantile glaucoma with trabeculodysgenesis. Both patients underwent multiple surgical procedures to control their glaucoma. The patients were on chronic systemic adrenal corticosteroid therapy for their anemia, which caused some confusion regarding the etiology of their glaucoma. To our knowledge, this is the first report of an association of infantile glaucoma with Diamond-Blackfan syndrome. We hope this report will encourage early recognition and treatment of glaucoma in patients with this disorder.

Child↗

The ophthalmologic manifestations of the cardio-facio-cutaneous syndrome.

The cardio-facio-cutaneous (CFC) syndrome is an uncommon multiple congenital anomalies/mental retardation syndrome whose major manifestations are congenital heart defects, relative macrocephaly, stunted growth, ectodermal dysplasia, characteristic facial appearance, and psychomotor developmental delay. All described cases were sporadic and cytogenetically normal. We report three additional patients with this diagnosis. All three patients developed strabismus, requiring extraocular muscle surgery. Two of our patients also had nystagmus. Combining the 18 previously reported cases with our additional 3, 9 of 21 had strabismus, 10 of 21 had ptosis, and 6 of 21 had nystagmus. Ophthalmic craniofacial abnormalities of hypoplastic supraorbital ridges, prominent epicanthal folds, and antimongoloid slant of the palpebral fissures were also common features contributing to the characteristic facies described for this syndrome. The ophthalmologist could aid in the diagnosis and treatment of these patients because of the prominent ophthalmologic symptomatology of the CFC syndrome.

Abnormalities, Multiple↗