Biomedical subjects
N Sarkies
Publications and source records attributed to N Sarkies.
Idiopathic intracranial hypertension: 12 cases treated by venous sinus stenting.
BACKGROUND: The high pressures documented in the intracranial venous sinuses in idiopathic intracranial hypertension (IIH) could be the result of focal stenotic lesions in the lateral sinuses obstructing cranial venous outflow. OBJECTIVE: To explore the relation between venous sinus disease and IIH. METHODS: 12 patients with refractory IIH had dilatation and stenting of the venous sinuses after venography and manometry had shown intracranial venous hypertension proximal to stenoses in the lateral sinuses. Intrasinus pressures were recorded before and after the procedure and correlated with clinical outcome. RESULTS: Intrasinus pressures were variably reduced by stenting. Five patients were rendered asymptomatic, two were improved, and five were unchanged. CONCLUSIONS: The importance of venous sinus disease in the aetiology of IIH is probably underestimated. Lateral sinus stenting shows promise as an alternative treatment to neurosurgical intervention in intractable cases.
Wanted: social contract for practice medicine. Acceptable practice needs to be determined by the public.
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Neurology of the pituitary gland.
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Benign intracranial hypertension. Pseudotumour cerebri: idiopathic intracranial hypertension.
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Intraocular pressure changes after peribulbar injections with and without ocular compression.
AIM: Two prospective studies were carried out in order to investigate (1) the rise in intraocular pressure (IOP) following peribulbar anaesthesia with a fixed volume of anaesthetic agent administered by a single surgeon, and (2) the efficacy of ocular compression with the Honan balloon for lowering IOP. Glaucomatous eyes were excluded from both studies. METHODS: In study group 1, 36 eyes of 36 patients undergoing cataract and/or implant surgery each received peribulbar injections consisting of 5 ml of anaesthetic from an inferotemporal site through the conjunctiva and a further 5 ml from a medial injection through the caruncle. IOP values were measured immediately before and after the injections and then after a variable period of external ocular compression. In study group 2, 20 eyes of 20 patients undergoing cataract surgery received peribulbar injections of local anaesthetic as above. IOP values were measured immediately before and after the injections and after 20 minutes without ocular compression. After a further 20 minute period with ocular compression the IOP was again measured. RESULTS: In study group 1, the mean immediate rise in IOP induced by the injections was 11.44 (95% confidence interval 8.97-13.90) mm Hg. The mean change in IOP after ocular compression was an overall fall of 2.42 (0.49-4.34) mm Hg from the pre-injection value. In study group 2, the mean injection induced rise in IOP was 9.45 (6.90-12.00) mm Hg. The mean fall in IOP during the first 20 minutes without ocular compression was 2.85 (1.20-4.50) mm Hg. During the second 20 minutes with ocular compression the mean fall in intraocular pressure was 11.05 (8.14-14.96) mm Hg. CONCLUSIONS: There is a large and individually variable rise in IOP following peribulbar anaesthesia. Ocular compression with the Honan balloon is effective in reversing this rise even when the initial rise is large.
Indicator-based audit of cataract surgery in four neighbouring hospitals in East Anglia.
To review and compare management and outcomes of patients undergoing cataract surgery in order to improve practice by identifying weaknesses and standardising best practice where appropriate, a concurrent and prospective audit from June to October 1993 was carried out in four neighbouring ophthalmic units in East Anglia. Six hundred and twenty-seven consecutive patients were undergoing cataract surgery in the audit period. The main measures and results were as follows: (1) Patients with visual acuity reduced to 6/60 or less should not wait longer than 3 months from consultation to surgery; 69.5% met standard. (2) Patients with visual acuity reduced to 6/18 or less should not wait longer than 12 months from consultation to surgery; 85.8% met standard. (3) Patients who have had cataract surgery should achieve 6/12 or better corrected visual acuity by 3 months post-operatively; 88.6% met standard. (4) There should be less than 2% sight-threatening complications of surgery; 4.2% suffered sight-threatening complications. (5) There should be no life-threatening complications of surgery; 100% met standard. The audit identified key areas of variation in practice, and analysis of reasons for differences in outcome has led to some changes in the management of patients with cataracts in the four units.
Papilloedema and visual failure in a patient with nocturnal hypoventilation.
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Pressor reactivity to norepinephrine and angiotensin in salt-sensitive hypertensive patients.
The mechanisms responsible for increased blood pressure in response to a high dietary sodium intake in salt-sensitive patients with essential hypertension are only partially understood. The possibility that increased reactivity to pressor hormones might contribute to hypertension in these patients has not been adequately investigated. We studied 11 salt-sensitive and 15 salt-resistant patients with essential hypertension while they were ingesting a diet with 20 meq/day sodium for 9 days or one with 200 meq/day sodium for 14 days. During the last 4 days of each dietary regimen, they received 30 mg/day of slow-release nifedipine. Blood pressure response to increasing doses of norepinephrine and angiotensin II (Ang II) was studied at the end of each of four phases of the study. Salt-sensitive patients exhibited a greater blood pressure response to norepinephrine than salt-resistant patients, irrespective of the dietary sodium intake and whether we took into account the dose infused or the actual plasma levels of norepinephrine achieved during the infusion. The blood pressure response to Ang II, on the other hand, was greater in salt-sensitive than salt-resistant patients during low but not during high sodium intake. The blood levels of norepinephrine achieved during the infusion of this hormone were lower in salt-sensitive than in salt-resistant patients. These studies indicate that an increased reactivity to the pressor action of norepinephrine might contribute to the maintenance of hypertension in salt-sensitive patients. The increased reactivity appears to be specific for norepinephrine. In fact, we observed increased reactivity to Ang II during low but not during high sodium intake.(ABSTRACT TRUNCATED AT 250 WORDS)
Antibodies to herpes simplex virus type I in intraocular fluids of patients with acute retinal necrosis.
The intraocular fluids and sera from three patients with acute retinal necrosis (ARN) and from 120 age-matched controls were tested for the presence of antibodies to herpes simplex virus type I (HSV-I). Antibodies to HSV-I were detected in both intraocular fluids and sera of two cases, and in intraocular fluids alone in one case of ARN. Among 120 control patients undergoing routine intraocular surgery antibodies to HSV-I were detected in the sera of 85 (79.2%) but in the intraocular fluids of only two (1.7%). The presence of antibody within the eye may indicate local antibody production, antibody sequestration within the eye, or damage to the blood ocular barrier.
What do we mean by usually?
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