Biomedical subjects
Publications and source records attributed to M F Kraushar.
Scleral depression with binocular indirect ophthalmoscopy will be easier to learn if the examiner observes the patient's pupillary reflex through the ophthalmoscope without looking through the hand-held condensing lens. When the tip of the scleral depressor is properly positioned the pupillary reflex will darken slightly. If the condensing lens is then moved into position the actual scleral depression will be visible.
The progression of a monocular nuclear cataract was observed for thirty-two months in an eye which was apparently otherwise normal. Three weeks after uncomplicated cataract surgery the patient presented with an apparent detachment of the choroid which enlarged dramatically within a relatively short time and which was further complicated by a retinal detachment. The subsequent development of rubeosis iridis and increased intraocular pressure suggested some other etiology. Ultrasonography revealed a malignant melanoma which was confirmed following enucleation. Transillumination of all suspected postoperative choroidal detachments is recommended with more definitive examination when indicated.
Of the many causes of serous detachment of the macula, toxoplasmic retinochoroiditis is one of the least common. A case presented which responded to only medical treatment. The clinical picture of this case is consistent with the theory that the organisms may in some instances reach the retina from the optic nerve through an embryologic extension of the ventricular system of the brain. Early diagnosis and treatment can prevent significant permanent visual loss as well as unnecessary retinal photocoagulation.
Line copy presentation slides with white letters on a blue background can be produced with a two-step process. The slides are more permanent than diazo slides, and the process is faster and less expensive.
A method for suturing extraocular muscles is presented which provides a safe, anatomically perfect means of reattaching extraocular muscles after recession, resection, or after disinsertion at retinal surgery.
The misconception that retrolental fibroplasia (RLF) occurs only in premature infants who have been exposed to excessive concentrations of oxygen is discussed. The fact that RLF occurs without exposure to oxygen is documented. Basic principles of jurisprudence regarding medical malpractice relating to RLF are discussed. Since RLF can occur without exposure to oxygen the doctrine of res ipsa loquitur should not apply. The burden of proof should still rest with the plaintiff.
A 3,800-g infant, born after 40 weeks' gestation, developed retrolental fibroplasia, documented by indirect ophthalmoscopy. Elevated arterial oxygen tensions may have occurred during brief treatment for two episodes of cyanosis.
Eight cases of surgically repaired lower canaliculi were studied to ascertain whether the lower canaliculus is necessary for normal lacrimal drainage and whether it is advisable to probe the superior canaliculus during inferior canalicular repair. Six of 8 patients sutdied had no epiphora despite unsuccessful surgery and a normal Schirmer"1 test. Surgery was successful on 2 pateints. These results indicate that only cosmetic repair is necessary for lacerated lower canaliculi. It is suggested that the upper canalliculus alone provides sufficient lacrimal drainage to prevent epiphora.
There is no accurate pre-treatment profile of the litigious patient. It is usually the lawsuit-causing physician who drives the patient to initiate litigation. The establishment and control of the physician-patient relationship are the keys to preventing litigation; this is achieved by improving physicians' ability to communicate, demonstrate empathy and support, and conduct appropriate discussion of informed consent. After treatment, physicians must pay special attention to patients who exhibit certain behavior typical of dissatisfaction. They should be accorded extra time and attention and, in some instances, should be referred to another practitioner for a second opinion and follow-up care.