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Biomedical subjects

R Friling

Publications and source records attributed to R Friling.

15 recordsLinked to original sources
PubMed2006

Combined propofol sedation with sub-Tenon's lidocaine/mercaine infusion for strabismus surgery in adults.

AIMS: To evaluate the safety and efficacy of propofol sedation combined with sub-Tenon's anaesthesia for strabismus surgery in adults. METHODS: Thirty-two consecutive patients aged 31-85 years underwent strabismus surgery under general (n=16) or local (n=16) anaesthesia. In the local anaesthesia (study) group, sedation was induced with a loading dose of midazolam, fentanyl, and propofol, followed by continuous infusion of propofol, 3-6 mg/k/h to deep sedation. A nasal tube was inserted to prevent airway obstruction. Sub-Tenon's anaesthesia included infusion of a 3-4 ml mixture (50 : 50) of lidocaine 2%/mercaine 0.5%. General anaesthesia consisted of premedication with midazolam, followed by fentanyl, esmeron-bromate, propofol, and tracheal intubation. Duration of surgery and anaesthesia, intraoperative oculocardiac reflex and arrhythmias, time to discharge, postoperative pain, nausea and vomiting, and patient and surgeon satisfaction were evaluated. RESULTS: The local anaesthesia group had a significantly shorter operative and anaesthesia time, fewer episodes of oculocardiac reflex or arrythmia/bradycardia requiring treatment, fewer early or late episodes of nausea and vomiting, and less pain. The patients and surgeon in this group reported higher satisfaction. CONCLUSION: Propofol sedation with local sub-Tenon's injection of lidocaine/mercaine is recommended for the induction and maintenance of anaesthesia during unilateral or bilateral strabismus surgery in adults. The method is quick and effective, without systemic or ocular side effects.

Adult↗
PubMed2005

Augmented trabeculectomy in paediatric glaucoma.

AIMS: To report the experience with trabeculectomy augmented with mitomycin C and 5-fluorouracil for the treatment of paediatric glaucoma. METHODS: Retrospective, interventional case series design was used. The sample included 17 children (29 eyes) with primary (19 eyes) or secondary (10 eyes) glaucoma who were treated with augmented trabeculectomy as the primary procedure between 1990 and 2002. Data were collected on age and family history, preoperative and end of follow up intraocular pressure, cup/disc ratio (evaluated by drawing), visual acuity, complications, and post-surgery treatment. RESULTS: Patient age at surgery ranged from 1 month to 8 years; most patients (n = 14, 82.3%) were aged less than 1 year (range 1 month-8 months, mean 3.95 (SD 2.56) months); three patients (17.7%) were aged 3, 5, and 8 years. The duration of follow up was 3-120 months (mean 46 months). Intraocular pressure significantly improved from 21 mm Hg to 60 mm Hg (mean 33.1 (10) mm Hg) before surgery to 6-26 mm Hg (mean 17.1 (6) mm Hg) after, (p <0.0001). There was no significant change in cup/disc ratio: 0.1-0.8 (mean 0.42 (0.26)) before and 0.1-1.0 (mean 0.511 (0.27)) after (p = 0.45). In 22 eyes (75.8%), intraocular pressure was controlled at less than 20 mm Hg and the cup/disc ratio remained stable or improved. The life table success rate for intraocular pressure control remained stable at 86% at the 12, 24, and 36 months and after 48 months decreased to 53%. There was no significant difference in the life table results between primary and secondary glaucoma. 14 eyes (48.2%) had a visual acuity better than 20/120 by the end of follow up. Repeated surgery was necessary in eight eyes (27.5%), and additional antiglaucoma treatment in 13 (44.8%). Complications included retinal detachment 1 year after surgery, choroidal detachment, and blebitis (one eye each). CONCLUSIONS: Augmented trabeculectomy with mitomycin C and 5-fluorouracil may serve as the primary procedure in a selected group of paediatric patients with glaucoma.

Antimetabolites↗
PubMed2004

Refraction and keratometry in 40 week old premature (corrected age) and term infants.

AIM: To compare refraction and keratometry readings between premature and term babies at 40 weeks' postconceptional age (PCA), and the possible effect of birth weight (BW) and gestational age (GA) on ocular parameters. METHODS: 33 preterm babies hospitalised in the neonatal unit between January and March 2002 were matched with 33 term babies born within the same period and hospitalised in the same unit. The preterm group underwent funduscopy at 4-5 weeks after delivery. Ophthalmic examination at 40 weeks' PCA included cycloplegic retinoscopy, funduscopy, and keratometric measurements. Mean and standard deviation of refraction, astigmatic power (plus cylinder), axis of astigmatism, and keratometric reading were calculated and compared between groups and correlated with BW and GA in the premature babies. RESULTS: Retinopathy of prematurity (ROP) stage 1 or 2 was noted in 88% of the premature babies on the first funduscopy examination, but only in 36% by the corrected age of 40 weeks. Statistically significant between groups differences were found for cycloplegic refraction (p = 0.02 for both eyes) and keratometry (p = 0.001 for both eyes). GA and BW had no impact on the refractive and keratometric findings in the preterm babies. CONCLUSIONS: Babies with mild ROP at the corrected age of 40 weeks have mild hypermetropia compared to the moderate hypermetropia found in term babies (a difference of 50%), and they have higher and steeper keratometric values. The greater corneal curvature may contribute to the development of myopia. Ophthalmologists and parents need to be aware of the possibility of visual dysfunction already very early in life even in relatively older premature infants.

Astigmatism↗
PubMed2004

Keratometry measurements in preterm and full term newborn infants.

AIM: To evaluate the relation between postconceptional age and birth weight with keratometric values in preterm and full term infants. METHODS: A prospective cross sectional study was performed. The cohort included 99 infants (198 eyes) admitted to the Neonatal and Neonatal Intensive Care Units at Schneider Children's Medical Center of Israel from February to September 2002. Keratometry in the horizontal and vertical meridians was performed in both eyes of each infant by two ophthalmologists using an autokeratometer. The results were evaluated according to: postconceptual age (<32 weeks, 32-36 weeks, >36 weeks) and birth weight (<1500 g, 1501-2500 g, >2501 g). RESULTS: Corneal curvature measurements decreased progressively with both postconceptual age and birth weight. At <32 weeks, mean (standard deviation) readings were 63.3 (3.2) diopters (D) for the horizontal meridian and 57.3 (2.6) D for the vertical meridian; corresponding values at >36 weeks were 54.0 (3.0) D and 50.7 (2.4) D. In the <1500 g group, mean (SD) readings were 61.3 (3.9) D for the horizontal meridian and 56.0 (2.9) D for the vertical meridian; corresponding values in the >2501 g group were 51.3 (2.1) D and 48.6 (1.8) D. CONCLUSIONS: There is an inverse relation of horizontal and vertical keratometric values with both postconceptional age and birth weight. Highest readings were noted in the babies with the lowest birth weight and youngest postconceptional age. The decrease in corneal dioptric power to normal values is linear and is apparently part of the normal ocular maturation.

Birth Weight↗
PubMed2000

Efficacy of diclofenac versus dexamethasone for treatment after strabismus surgery.

OBJECTIVE: To compare the efficacy of topical diclofenac sodium 0.1% versus dexamethasone 0.1% on the conjunctival healing process and on intraocular pressure (IOP) after strabismus surgery. DESIGN: A randomized clinical trial. PARTICIPANTS: Forty consecutive pediatric patients who underwent strabismus surgery. INTERVENTION: The patients were assigned before surgery to receive topical diclofenac 0.1% (study group, 20 patients) or dexamethasone 0.1% (control group, 20 patients) from immediately after surgery to up to 4 weeks after surgery (both combined with chloramphenicol 0.2%, polymyxin B sulfate 2500 U). MAIN OUTCOME MEASURES: Between-group comparison of five parameters: patient discomfort, conjunctival chemosis, inflammation, gap, and intraocular pressure (IOP) at 1, 2, and 4 weeks after surgery. RESULTS: At postoperative week 2, the diclofenac-treated group showed significantly less patient discomfort and less conjunctival inflammation, edema, and gap than the dexamethasone group (P: = 0.003, P: = 0.04, P: = 0.02, P: = 0. 001, respectively). At week 4, the study patients continued to show less discomfort and conjunctival gap (P: = 0.02). The dexamethasone group showed a significant change in IOP between the preoperative and the fourth postoperative week (P: = 0.001 in the right eye, P: = 0.0005 in the left eye) and an increased prevalence of higher IOP during the fourth postoperative week (P: = 0.01 in the right eye, P: = 0.02 in the left eye). Thirty-eight percent of the dexamethasone group showed an increase in IOP to more than 21 mmHg during the four postoperative weeks. No increase in IOP was noted in the diclofenac group. CONCLUSIONS: Topical diclofenac is superior to dexamethasone for each of the five postoperative parameters examined. Its maximal effect occurred at 2 weeks after surgery, without an increase in IOP or in local subconjunctival hemorrhage.

Adolescent↗
PubMed1999

Changes as the result of ageing in extraocular muscles: a post-mortem study.

BACKGROUND: Extraocular muscles differ from typical skeletal muscle in many respects such as smaller fibre size, high mitochondrial content, unusual contractile/innervation patterns and highly developed microvascular bed. Changes in typical skeletal muscle with ageing have been well documented yet the reports on ageing changes in extraocular muscles is limited. The aim of this study was to examine these changes. METHODS: The right inferior and medial rectus muscles were removed at post-mortem from patients with no history of prior ocular or neuromuscular disease. These included 25 patients aged between 23 and 88 years (14 male, 11 female). The median age of the patients was 69 years and 72% of patients were aged older than 66 years. The median post-mortem interval was 28 h, RESULTS: In young adults between 20 and 30 years of age, the muscle fibres were regular, of fairly uniform size with minimal endomysial connective tissue and no lipofuscin was detected in fibres. In adults between 40 and 50 years of age, a small amount of subsarcolemmal lipofuscin was detected. Between 50 and 60 years of age, a few fibres with reduced density of myofibrils were noted. All patients over 65 years had definite changes of ageing and those between 70 and 80 years of age showed similar features to those between 60 and 80 years of age. These changes included variation in fibre size, increased endomysial fibrous tissue and increased endomysial adipose tissue, and loss of myofibrils with some fibres devoid of fibrils and comprising 'bags' of mitochondria. There was increased lipofuscin in a number of fibres, increased 'degenerative' changes such as vacuolation of fibres, scattered 'eosinophilic intracytoplasmic bodies' and increased numbers of 'ringbinden'.

Adult↗
PubMed1998

The Heimann-Bielscholwsky phenomenon: dissociated vertical nystagmus.

BACKGROUND: The Heimann-Bielschowsky phenomenon (HBP) is a unilateral vertical nystagmus with coarse, slow pendular movements that typically occurs in an eye with profound visual loss. There are no sinister neurological implications. METHODS: Symptoms and signs on presentation and the subsequent course are described in detail in 10 patients. Eye movements were recorded for one patient. RESULTS: Three patients had corrected vision of 6/24 or better. Strabismus was seen in eight patients. Symptoms of diplopia and oscillopsia were infrequent. CONCLUSIONS: We believe that the HBP may be a reasonably common condition, although very under diagnosed. This condition may be similar to Central Fusion Disruption. Patients with HBP appear to have lost the potential for fusion.

Adolescent↗
PubMed1994

Rhabdomyosarcoma: invading the orbit in an adult.

Sites in the head and neck region are among the most frequent locations of rhabdomyosarcoma (RMS) in patients younger than 15 years. However, comparable neoplasms in adults are very uncommon. We present a case report of a 27-year-old man who was diagnosed as having RMS. RMS rarely presents in the head and neck of adults, but should be considered in the differential diagnosis of a small cell neoplasm in patients during the third and fourth decades of life.

Adult↗
PubMed1993

[Unilateral proptosis due to cholesterol granuloma].

Cholesterol granuloma is a rare cause of unilateral proptosis. We describe a 42-year-old man who presented with painless swelling of the left upper brow of a few months duration. Biopsy showed crystals of cholesterol surrounded by giant cells.

Adult↗
PubMed1990

[Recurrent episodes of central retinal artery occlusion].

A 70-year-old man with arteriosclerosis of the carotid arteries developed acute occlusion of the central retinal artery and blindness during intravenous pyelography. 40 minutes after the occlusive episode he underwent paracentesis of the anterior chamber and vision returned (6/18). During the next 2 weeks, while receiving aspirin and then intravenous heparin, there were recurrent episodes of arterial occlusion and blindness that were immediately treated by repeated paracenteses of the anterior chamber. Visual activity again returned to 6/18 and his condition has remained stable as of his last clinic visit, 3 months after the first episode.

Aged↗
PubMedDate not supplied

Retinopathy of prematurity in multiple-gestation, very low birth weight infants.

Ninety-nine infants from multiple gestation births and weighing < or = 1500 g at birth were matched with infants from single births to clarify the relationship of multiple gestation to retinopathy of prematurity (ROP). There was no significant difference in the incidence of ROP between the twins and the singletons (relative risk [RR] = 0.84, 95% confidence intervals [CI] = 0.61, 1.16). Logistic regression analysis confirmed that very low birth weight (VLBW), not single or multiple gestation, was the most significant predictor of ROP occurrence in either group. In 27 pairs of twin siblings from the original twin group, where both weighed < or = 1500 g at birth, we found that the second-born twin seemed at higher risk for developing ROP, but logistic regression showed that the lower birth weight of the second twin, not birth order, was the more significant predictor of ROP. These results indicate that ROP screening in VLBW twins may be conducted according to the same standard protocols as for singletons.

Birth Order↗
PubMedDate not supplied

A role of transforming growth factor-beta 1 in the control of corneal neovascularization.

Transforming growth factor beta 1 (TGF-beta 1) has been implicated in both the stimulation of angiogenesis in vivo and in the inhibition of endothelial cell proliferation in vitro systems. In this study we present evidence showing that under certain experimental conditions TGF-beta 1 may inhibit neovascularization in vivo. TGF-beta 1 was incorporated into ethylene vinyl acetate copolymer (Elvax 40) matrixes which provide a valuable vehicle for the controlled and sustained delivery of bioactive peptides. The biological effectiveness of TGF-beta 1 sequestered in polymer matrices was assessed by measuring the inhibition of [3H]-thymidine incorporation into the DNA of cultured mink lung epithelial cells. Neovascularization was induced in both corneas of albino rabbits by one deep-seated limbal silk suture. Elvax 40 matrixes loaded with TGF-beta 1 (release rate, 1.66 ng/24 h) were implanted in rabbit corneal stroma. "Empty" polymers in the contralateral eye served as controls. Aliquots of aqueous fluid were withdrawn, and the presence activity of phagocytic cells was assessed by the production of superoxide anion (O2) which was measured by the superoxide dismutase-inhibitable reduction of ferricytochrome C. Polymer-enclosed TGF-beta 1 implanted in rabbit corneas significantly suppressed angiogenesis (2.65 +/- 0.4 mm compared to 3.05 +/- 0.3 mm in contralateral controls p < 0.05). Superoxide production in 100 microliters aliquots of aqueous fluid was 0.95 +/- 0.18 and 0.6 +/- 0.18 nmol O2/10 min in control eyes and in the eyes bearing sequestered TGF-beta 1, respectively (p < 0.02). These results indicate that under the experimental conditions selected in this study, TGF-beta 1 significantly suppressed in vivo angiogenesis.

Animals↗