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Biomedical subjects

Gregory S Kosmorsky

Publications and source records attributed to Gregory S Kosmorsky.

7 recordsLinked to original sources
PubMed2005

Optic neuropathy in vitamin B12 deficiency.

There are many neurological manifestations of vitamin B(12) deficiency. Optic neuropathy is a rare, but important, manifestation of vitamin B(12) deficiency that should be suspected in patients with risk factors for malnutrition. We present a case of a 68-year-old male who presented with bilateral decreased central vision for months and was found to have a low vitamin B(12) level. After a few months, his vision improved with parenteral vitamin B(12) supplementation. Vitamin B(12) optic neuropathy is a reversible, treatable cause of vision loss and may be a harbinger for other manifestations of the disease.

Journal Article↗
PubMed2004

Prevalence of psychosocial disturbances in children with nonorganic visual loss.

PURPOSE: To report on the prevalence of psychiatric disease and psychosocial stress in children with nonorganic visual loss. MATERIALS AND METHODS: Case series of 71 consecutive pediatric patients with a variety of nonorganic visual signs and symptoms. Chart review of ophthalmologic findings and details of medical and social history with main outcome measures of prevalence of psychiatric disease and psychosocial stress. RESULTS: Psychological/psychiatric disturbances in the form of anxiety, depression, and attention deficit hyperactivity disorder had been previously diagnosed in 19 (26.7%) patients. We had a very high index of suspicion of psychiatric illness in another four patients. Furthermore, we uncovered significant home and school stress in 22 (31%) patients. Sixteen (22.5%) patients wanted glasses and in 10 (14.1%) patients no cause for the behavior could be determined. Of those patients who wanted glasses, girls outnumbered boys 3:1. CONCLUSIONS: An underlying psychiatric or psychosocial disturbance should be ruled out in children who present with nonorganic visual loss.

Adolescent↗
PubMed2003

Surgical quality assurance in the Ischemic Optic Neuropathy Decompression Trial (IONDT).

The purpose of this article is to report the methods and results of the surgical quality assurance program associated with the Ischemic Optic Neuropathy Decompression Trial (IONDT). A surgical quality assurance committee developed and implemented a quality assurance program for a randomized clinical trial requiring surgical intervention. A surgical technique questionnaire was administered at two times during the study course, and maintenance of surgeon certification required submission and approval of a masked videotape of an optic nerve sheath decompression surgery by each study surgeon. Surgical quality was assessed through completion of surgical report forms and standardized, masked review of operative notes. Rates of compliance and intra- and interreviewer agreement were assessed for each aspect of the program. Twenty-five of 32 surgeons (81%) successfully completed and maintained certification. Item agreement varied from 21-92% among reviewers of satisfactory videotapes and 22-89% on unsatisfactory videotapes. Intrarater agreement for videotape acceptability was 11 of 13 (85%), and for specific surgical steps, 147 of 182 (81%). Operative notes were submitted for 123 of 125 (98%) patients receiving surgery. Interrater agreement on individual items ranged from 73-100%. Classification of individual items was identical on first and second review for 1285 of 1344 (95.6%) items. Overall agreement for individual reviewers was 93.8-97.8%. We conclude that use of a small peer review committee, which developed and oversaw a quality assurance program, allowed for consistent certification and monitoring of surgical performance. This in turn increased the credibility of the IONDT results, which demonstrated no difference in outcome between operated and unoperated groups of patients.

Certification↗
PubMed2003

Ocular ethambutol toxicity.

Ethambutol is an antimicrobial agent used frequently to treat tuberculosis. The most commonly recognized toxic effect of ethambutol is optic neuropathy, which generally is considered uncommon and reversible in medical literature. We describe a 43-year-old man who developed signs and symptoms of bilateral optic neuropathy during treatment with ethambutol. This case and a review of the literature show the severe and unpredictable nature of ethambutol toxicity and its potential for irreversible vision loss despite careful ophthalmologic monitoring.

Adult↗
PubMed2002

Chest computerized tomography in the evaluation of uveitis in elderly women.

PURPOSE: To describe the usefulness of chest computerized tomography (CT) in the evaluation of uveitis in elderly women and the clinical characteristics of patients with an abnormal chest CT scan. DESIGN: Prospective noncomparative case series. METHODS: We evaluated 30 elderly women, aged 61-83 years, with chronic iritis, vitritis, or choroiditis and with no definitive cause for their uveitis. All patients underwent a battery of diagnostic laboratory studies and chest CT. RESULTS: The diagnostic examination in most patients included serum angiotensin converting enzyme level, serum lysozyme, rapid plasma reagin level, fluorescent treponemal antibody-absorption test, purified protein derivative skin test, and chest x-rays. Chest CT performed on all patients showed parenchymal, mediastinal, and/or hilar adenopathy in 17 patients (57%). Histopathologic confirmation of sarcoidosis with noncaseating granulomas in the biopsy specimens was obtained in 14 patients: eight by mediastinoscopy, two by bronchoscopy, two by conjunctival biopsy, one by nasal biopsy, and one by vitreous biopsy. CONCLUSIONS: Chest CT can be useful in elderly female patients with chronic uveitis for identifying mediastinal lymphadenopathy and other lesions suggestive of sarcoidosis, as well as to help guide tissue confirmation and to rule out other diagnoses including lymphoma.

Aged↗
PubMed2002

Gabapentin attenuates superior oblique myokymia.

PURPOSE: To investigate therapeutic effects of oral gabapentin therapy on superior oblique myokymia. DESIGN: Observational case series with measurement of visual acuity and eye movements before, during, and after therapy. METHODS: Two adult patients with superior oblique myokymia, refractory to other therapies, were treated with gabapentin orally after informed consent was obtained. Eye movements were measured using the magnetic search coil technique. RESULTS: Superior oblique myokymia completely resolved after starting gabapentin. CONCLUSION: Gabapentin may be an effective treatment for superior oblique myokymia; a double-blind study seems justified.

Acetates↗