Biomedical subjects
J L Pearce
Publications and source records attributed to J L Pearce.
Distribution of toxigenic Escherichia coli serotypes in the intestines of infants.
As part of an ongoing study into the pathogenesis of sudden infant death syndrome (SIDS), the distribution of serotypes of toxigenic and non-toxigenic Escherichia coli within the gastrointestinal tract of babies who had died was investigated. Escherichia coli isolates from the mid-ileum, colon and rectum of six SIDS cases and one case which had died suddenly and unexpectedly but had underlying cardiac pathology were "O" serogrouped and examined for verocytoxic activity and production of heat-labile enterotoxin. In addition, the effect of storage of gut specimens and rectal swabs at 4 degrees C on isolation of toxigenic strains was studied in three of the cases. A diversity of serogroups and toxigenicity was a general finding, however, strains found in the proximal gut were also cultured from the rectum, indicating that faecal specimens would be a valid tool in investigating the role of these organisms in SIDS cases compared with healthy controls. Storage for up to 5 days at 4 degrees C had no appreciable effect on isolation rates of toxigenic bacteria.
A complication of orbital emphysema.
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Recessively determined chylous ascites--a case report and possible mouse model.
A male infant, whose parents were first cousins, was born with tense chylous ascites, mild generalized oedema and facial dysmorphism. The baby initially seemed well but subsequently probably aspirated, developed septicaemia and finally died at 26 days from a bleeding diathesis, possibly secondary to liver dysfunction. No cause for the chylous ascites was found at post mortem. This case is presumed to represent an example of recessively determined chylous ascites. The mouse mutant Chy may be an homologous condition.
Review of a series of disc lens implants.
A consecutive series of 380 patients (431 eyes) implanted with the Pearce Lasadisc Lens are reviewed, of which 225 patients (255 eyes) underwent detailed assessment. The operative technique for implanting the disc lens is described and the importance of superior capsular bag fixation is discussed. Postoperatively 89.9% of eyes achieved a best corrected visual acuity of 6/12 or better. Five (1.2%) of the implants were removed; three due to lens decentration causing visual problems, one after dislocating into the anterior chamber, and one after causing pupil block glaucoma. One implant dislocated into the vitreous.
Atypical pneumonia caused by dual infection with Legionella pneumophila and Mycoplasma pneumoniae.
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Topical use of indomethacin on the day of cataract surgery.
The use of topical indomethacin in the prevention of surgically induced miosis has been documented. However, in these previous prospective trials this prostaglandin synthetase inhibitor was administered the day before surgery. With the frequency of 'day case' cataract surgery increasing, an efficient preoperative mydriatic regimen is important. In this study we considered the use of topical indomethacin as an addition to a regimen already implemented. One hundred and fourteen eyes underwent intercapsular cataract surgery, of which 64 were randomised to receive topical aqueous indomethacin one hour beforehand, and 50 eyes, which did not receive indomethacin formed the comparison group. Topical indomethacin reduced the miosis which occurs during cataract surgery whether performed under local or general anaesthesia. The operating time was shorter for eyes with less surgically induced miosis.
Intercapsular versus extracapsular cataract extraction.
Forty-five eyes that have undergone routine extracapsular cataract extraction with insertion of a posterior chamber intraocular lens were compared with a similar group of eyes that had undergone intercapsular extraction. Capsular fixation was more predictable following intercapsular (78%) than it was following extracapsular extraction (22%). Gonioscopy revealed prominence of the lens haptic in 22% of the intercapsular group, with peripheral anterior synechiae (PAS) in 18%; haptics were prominent in 78% of the extracapsular group, with synechiae in 55%. Lens eccentricity of 2 mm or more was seen in 2 patients (4%) following intercapsular and in 10 (22%) following extracapsular extraction. Pupil irregularities were noted in three of the intercapsular group (7%) and in eight of the extracapsular group, (13%) with peripheral iris tucking alone in three. These data strongly support the view that intercapsular is superior to extracapsular cataract surgery in terms of facilitating capsular fixation of posterior chamber intraocular lenses.
A new cannula for nucleus hydrodissection.
This disposable 25-gauge cannula has a specially designed distal segment which facilitates crystalline lens nucleus hydrodissection or viscodissection. The injection of a fluid or viscous material creates a cleavage plane between the nucleus and cortex or capsule, thus facilitating extraction of the nucleus. The flattened, smooth, cannulated tip allows easier insertion and manipulation under the capsule.
Day-case cataract surgery.
The results of a series of 40 cataract extractions with lens implantation performed on day-case patients under local anaesthesia are reported. The ways in which modern surgical techniques have rendered this a safe procedure are described, and the potential benefits of day-case intraocular surgery are discussed.
Implantation of a disc lens in the capsular bag.
We report a series of 65 cataract extractions with implantation of a rigid, posteriorly vaulted, disc-shaped lens in the capsular bag. Eight-nine percent achieved 20/40 vision or better, and 54% achieved 20/20 vision or better. The lens remained well centered in all cases. The method is described, and the practical and theoretical advantages of implantation of a lens approaching a natural shape are discussed.
Clinical results of the multifocal lens.
The multifocal posterior chamber intraocular lens was implanted in 46 eyes of 38 patients as part of the first clinical trial of this target-type implant. No major complications were reported. Visual acuity results for distance and near vision were excellent, with best case visual acuities better than 20/40 in over 95% of eyes in the first three months.
Modern cataract surgery in a highly myopic population.
A retrospective series of 117 highly myopic eyes with extracapsular cataract extractions and posterior chamber lens implants is presented. The results are analysed with reference to the current understanding of the complications anticipated. Of particular note is the use of low-powered posteriorly vaulted posterior chamber implants, with and without primary posterior capsulotomy. The results show a low retinal detachment rate (one eye, mean follow-up 12 months); low induced astigmatism (average 0.86 D); low myopic postoperative refraction (median -1.0 D); and high patient satisfaction.
Protective barrier effect of the posterior lens capsule in exogenous bacterial endophthalmitis: a case report.
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An unusual legionellosis case yields the first New Zealand isolation of Legionella dumoffii.
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Children with asthma: will nebulised salbutamol reduce hospital admissions?
To find out how many children with acute asthma responded to one or two doses of nebulised salbutamol and whether this response could be predicted 100 children were studied prospectively from two district hospitals. Twenty three children needed only one nebulised dose and 19 responded to two. Significant factors differentiating these responders from the remainder were age (24 (63%) of those aged 6 or more responded compared with only six (19%) of those aged 3 or less); regular treatment with a beta 2 sympathomimetic; and use of a rotahaler or aerosol. Those requiring more intensive treatment had faster pulse and respiratory rates on admission and one hour after the first nebulised dose. Another useful clinical sign was persistent supraclavicular indraw. Pulsus paradoxus and peak expiratory flow rate were of limited value in the younger children who had worse asthma. Of 29 children receiving intravenous treatment, 18 (62%) were aged 3 or less, whereas only two (7%) were aged 6 or over. The older children who responded initially to nebulised salbutamol could have been safely reassessed at home, which would have considerably reduced hospital admissions.
Retrospective study of 67 cases of secondary pars plana posterior capsulotomy.
A technique of late pars plana posterior capsulotomy following extracapsular cataract extraction and posterior chamber lens implantation is described. The results and complications of 67 cases with an average follow-up period of approximately 14 months are reported. The incidence of cystoid macular oedema following this procedure was 2.9%, with no incidence of retinal detachment. The procedure appears to be an acceptable method of treating a thickened posterior capsule, and in the absence of a neodymium YAG laser and in a small unit it could prove to be a reasonable substitute.
Capsular fixated posterior chamber lenses in high myopia.
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