Biomedical subjects
Publications and source records attributed to G M Bohigian.
American medicine and health care delivery is undergoing dramatic changes. Part of the problem is lack of direction, communication, and the inability of the physicians to work together. Physicians in the future will need to join forces. The past, present, probable and possible future of American medicine is discussed.
BACKGROUND AND OBJECTIVE: To determine the incidence of culture-positive endophthalmitis after cataract surgery in an ambulatory surgical care center and to analyze the effectiveness of povidoneiodine solution in the preoperative preparation in preventing culture-positive endophthalmitis. PATIENTS AND METHODS: A retrospective series of 19,269 consecutive cases of cataract extraction with lens implantation over 12 years in an ambulatory care center was reviewed. RESULTS: Nine cases of culture-positive endophthalmitis occurred, for an incidence of 0.05%. The initial 4,740 cases (1985-1989) were performed without the use of povidone-iodine; the following 14,529 cases (1990-1996) were done using povidone-iodine. The incidence of culture-positive endophthalmitis was 0.08% and 0.03%, respectively. CONCLUSION: The incidence of culture-positive endophthalmitis in this series was very low. The use of 5% povidone-iodine, topically, appeared to be beneficial in reducing the incidence of culture-positive endophthalmitis after cataract extraction (P=0.24), but was not statistically significant in this retrospective series. Evaluation and methods to prevent endophthalmitis are difficult in retrospective clinical studies due to multiple variables and the rarity of this complication.
PURPOSE: We report two cases in which retained nuclear fragments in the anterior chamber after phacoemulsification and posterior chamber lens implant resulted in intraocular complications. METHODS: Case reports. RESULTS: In two eyes of two patients, retained nuclear fragments resulted in minimal anterior chamber reaction but substantial corneal edema and reduced visual acuity. Topical anti-inflammatory medications did not alter the postoperative course. Improvement occurred only when the nuclear fragments were surgically removed. CONCLUSIONS: Retained nuclear fragments in the anterior chamber can cause corneal edema and reduced vision that may be reversed by removing the fragments.
The Staff of Asclepius is one of the most common symbols associated with medical profession. The emblem of a single snake and a staff is a true representation of medicine in contrast to the caduceus. The origin, meaning, and evolution of the Staff of Asclepius is found in antiquity.
Substance abuse and dependence (alcohol and drugs) are behavioral disorders and treatable medical diseases. There is growing concern in the medical community for physicians impaired by these diseases. The Missouri Physicians' Health Program has been established to help impaired physicians return to healthy personal and professional lives. This confidential voluntary program of early referral, intervention, treatment, monitoring, and advocacy has been highly successful. The average recovery rate in this study of 146 participants was 94%.
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Substance abuse and dependence (alcohol and drugs) are behavioral disorders and treatable medical diseases. Early intervention followed by appropriate treatment can often help return physicians to healthy personal and professional lives. Current scientific evidence suggests the prevalence of substance abuse or dependence among the medical profession over a lifetime is approximately 10-15%, slightly in excess of the general population. The initiation of intervention is critical and ultimately may be lifesaving.
Missouri Physicians Health Program (MPHP) was established to help impaired physicians return to healthy personal and professional lives. One percent of Missouri physicians will suffer some sort of impairment; ie: substance abuse, or dependency of drugs or alcohol within a year. This is a confidential voluntary program. This program of early referral, intervention, treatment and monitoring advocacy has been highly successful. The average recovery rate in this study of 75 participants was 92%.
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The use of vitrectomy in the management of endophthalmitis is controversial. All cases of suspected clinical endophthalmitis should have immediate anterior chamber and vitreous aspiration combined with an intravitreal antibiotic/steroid injection. Vigorous systemic, topical and periocular therapy should accompany frequent examinations of the patient. Vitrectomy is recommended in selected clinical situations. An intraocular lens usually can be left in place and should be removed only in certain rare instances.
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In a retrospective study of 82 cases of endophthalmitis treated between 1976 and 1982 at Barnes Hospital-Washington University, St. Louis, Missouri, 51 (62%) cases were culture-proven. Forty-nine (60%) were associated with cataract extraction, 16 cases (20%) were associated with trauma, and 17 cases (20%) were associated with other events. Sixty-four patients (78%) had undergone neither anterior chamber nor vitreous paracentesis before referral. Seventeen of the 51 culture-proven cases were initially thought to be sterile inflammatory responses and not infectious by the referring ophthalmologist. A poor visual result (visual acuity of less than 20/400) was associated with positive cultures, accidental trauma, virulent organisms, poor initial visual acuity, or a combination of these.
This study suggests that there is a higher incidence of infectious corneal ulcers with soft contact lenses than with hard contact lenses. Pseudomonas aeruginosa was the most commonly identified organism associated with soft contact lens corneal ulcers. Early and aggressive management can improve the prognosis of this disease. A plan of therapy and management is recommended and discussed.
A clinical study was done to evaluate the common treatment modalities of chalazions. The effectiveness of 2 current therapies on an alternative case basis was done. This was correlated with bacteriology, underlying ocular disease, percentages of spontaneous cure and refractive error. The average clinical course revealed that approximately 50% of chalazions can be expected to be cured or improved with medical treatment within 1 month.
It has been suggested that corticosteroids plus the effective antibiotics are more beneficial than antibiotics alone in reducing inflammation in infectious keratitis. Topical and subconjunctival corticosteroids as adjuncts to gentamicin therapy were evaluated by microbiological assay and clinical parameters in experimentally induced Pseudomonas keratitis in rabbits. Various strengths of dexamethasone given concurrently or delayed in conjunction with gentamicin therapy were studied. There was no statistically significant difference between combinations and the antibiotics alone in this experimental model.
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