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Biomedical subjects

S J Bass

Publications and source records attributed to S J Bass.

16 recordsLinked to original sources

Atypical herpetic endotheliitis.

BACKGROUND: Three patients ranging in age from 26 to 40 years presented with unilateral posterior stromal lesions with diffuse stromal edema. There was no history of prior surgery, trauma, infectious disease, dystrophy or exposure to noxious agents. Only one patient had signs of anterior chamber reaction and none of the patients showed any sign of epithelial involvement or of associated blood vessels or scarring. All three patients presented with features atypical of herpetic disease, such as lack of epithelial involvement and posterior stromal opacification. They also demonstrated many of the typical characteristics of herpetic disease, however, and thus were diagnosed as having herpetic endotheliitis. RESULTS: All three patients were treated with a regimen of antiviral agents and corticosteroids. Two patients improved, although the time frame differed in each. One patient subjectively improved, then worsened 1 month later after discontinuing treatment on her own. She was lost to subsequent follow-up. CONCLUSIONS: Young patients presenting with unilateral posterior stromal opacification and stromal edema in the absence of epithelial involvement are likely to have endotheliitis of herpetic origin.

Adult

Evaluation of acute urinary tract infection in children by dimercaptosuccinic acid scintigraphy: a prospective study.

A prospective study examining the incidence of dimercaptosuccinic acid (DMSA) abnormalities in children at the time of acute urinary tract infection, the progression of these abnormalities following treatment and their correlation with the presence of vesicoureteral reflux is reported. DMSA scans performed within 72 hours of presentation in 65 previously healthy children with acute urinary tract infection were abnormal in 34 (52%). The scan appearances of 30 of 36 (83%) initially abnormal kidneys improved or became normal on the repeat DMSA study performed at 3 to 6 months after the acute urinary tract infection. A cystogram demonstrated significant vesicoureteral reflux in 11 of 45 cases (24%). Of these 11 cases 10 had abnormal DMSA studies and 1 had dilated upper tracts on ultrasound. Several conclusions may be drawn from our study. The incidence of DMSA abnormalities at the time of acute urinary tract infection is high but these abnormalities tend to resolve with time. An abnormal DMSA study at the time of urinary tract infection identifies most children with significant vesicoureteral reflux, and in our series a combination of ultrasound and DMSA identified all cases. This study may have major implications for the clinical investigation of children with urinary tract infection.

Acute Disease

The detection of reflux nephropathy in infants by 99mtechnetium dimercaptosuccinic acid studies.

Dimercaptosuccinic acid (DMSA) studies were performed in 113 infants less than 1 year old at risk of renal scarring. Of these patients 86 presented with urinary tract infection and 27 were asymptomatic. A voiding cystourethrogram was performed in all cases and excretory urography (IVP) was done in 99. More abnormalities were detected by DMSA study when compared to scars on IVP. When both studies were abnormal there was an excellent correlation on a site by site basis. Fever or systemic disorder was not a reliable sign to determine whether there was upper tract involvement with infection. The incidence of DMSA abnormalities in infants increased with high grade vesicoureteral reflux and decreased with low grade reflux. There was no significant difference in the incidence of abnormal kidneys between the infected and noninfected groups, suggesting that renal scarring may occur with sterile reflux.

Female

Corneal dystrophies.

Corneal dystrophies are inherited (usually autosomal dominant) disorders involving virtually every layer of the cornea. They result in opacities of various sizes and shapes that primarily affect the central cornea relatively early in life. Diagnosis is most often based on clinical appearance and careful biomicroscopic examination to assess the corneal layer(s) that are affected. Because most dystrophies are slowly progressive, visual acuity is often minimally affected for much of an individual's lifetime. Dystrophies are not associated with any prior corneal inflammations or systemic disease. This paper is a discussion of the most commonly encountered dystrophies affecting the epithelium, Bowman's membrane, stroma, and endothelium. The optometric management of many of these dystrophies may, at times, present a challenge to the clinician. Treatment may range anywhere from a simple therapeutic contact lens to referral for penetrating keratoplasty.

Contact Lenses

Optic pit, microphthalmos and orbital cyst.

An orbital cyst was discovered by ultrasonography behind the globe of the left eye in a five-year-old boy with a left esotropia. In addition, an optic pit was present in the optic nerve head of the same eye, which was microphthalmic relative to the right eye. Although orbital cyst has been reported in the literature, this case is of interest because of the presence of two congenital anomalies in the same eye - namely, optic pit and orbital cyst. These two conditions have never been previously reported as existing together in the same eye.

Child, Preschool

Visual evoked potential (VEP) delays in central serous choroidopathy.

The authors examined a series of ten consecutive patients with unilateral, idiopathic central serous choroidopathy. Visual acuities ranged from 20/20 to 20/70 during the active stage. VEPs were recorded to square sizes of 14, 28, and 56 min of arc. Overall, 90% of the patients had statistically significant VEP delays from the affected eye, while only 30% had statistically significant reductions in amplitude during the active stage. Six of the ten patients were reevaluated after the condition fully resolved. In all six, the VEP latency returned to normal. Although the mechanism of these VEP delays is not clear, their presence has been well documented. Therefore, a VEP delay in isolation of other tests should not be used in the differential diagnosis of macular vs optic nerve disease. One should specifically rule out macular disease in any patient with a delayed VEP before presuming the presence of a visual pathway dysfunction.

Adult

Visual evoked potentials in macular disease.

Although a delayed visual evoked potential is considered to be the hallmark of optic nerve disease, relatively little has been published about VEP delays in macular disease. In this study, 20 patients with either acquired unilateral maculopathy or bilateral maculopathy in which one eye was more affected than the other were evaluated. VEP amplitudes and peak latencies were compared between eyes when recordable. Nine patients (45%) exhibited significant interocular delays in the affected or more affected eye while only four patients (20%) exhibited significant interocular attenuations in amplitude. In the nine patients exhibiting delays, three patients had a visual acuity of 20/30 or better in the affected eye or more affected eye. In the patients exhibiting amplitude attenuations, no patient had a visual acuity better than 20/50 in the affected or more affected eye. Although the mechanism of VEP delays in maculopathy is not clear, a VEP delay, in isolation of other tests, should not be used in the differential diagnosis of macular vs optic nerve disease. The clinician should specifically rule out macular disease in any patient with a delayed VEP before presuming the presence of a visual pathway dysfunction.

Adolescent

Ocular manifestations of AIDS.

The acquired immunodeficiency syndrome (AIDS) is a devastating disease which continues to claim the lives of most of its victims. Despite the media's silence, AIDS has in no way disappeared. Over 4,400 cases have been reported thus far and many more new cases are reported each week nationwide. The ocular manifestations of AIDS should alert the doctor of optometry to the possibility of an AIDS suspect, especially if the patient is in one of the major risk categories. Early detection of this disease may permit more prompt treatment and thus a better prognosis for the AIDS patient.

Abducens Nerve

Aeromonas hydrophilia: a rare and potentially life-threatening pathogen to humans.

The authors discuss the diagnosis, symptoms, and treatment of infections resulting from Aeromonas hydrophilia, and uncommon pathogen that is being reported with increasing frequency and may be serious to man. They present the case history of a 38-year-old male and emphasize the importance of prompt and proper treatment.

Accidents, Traffic

The differential diagnosis of retinal disease from optic nerve disease.

Patients complaining of reduced acuity in the absence of a clearcut diagnosis present a challenge to the eye care practitioner. It is important to differentiate retinal disease from optic nerve disease as the etiology of the decrease in vision. This differentiation can have significant ramifications and must be determined for patient welfare and management. Several procedures may be used in making the differential diagnosis of macular or retinal from optic nerve disease. Some of these procedures are easy to perform and include Amsler grid, color vision testing, pupillary reflexes, light-brightness comparison, and macular dazzle. Other procedures require a greater degree of sophistication and include fluorescein angiography, the Visual Evoked Potential (VEP) and simultaneous VEPs and ERGs (Electroretinograms). The clinician should be aware of all of these procedures and how each may be useful in this differential diagnosis.

Color Perception Tests

The pivotal metatarsal osteotomy: a modification of the metatarsal metaphyseal osteotomy.

The presence of cancellous bone determines the choice of location for osteotomies in the metatarsals. The head and base have good cancellous bone, whereas the shaft has cortical bone and a medullary canal which make it a poor choice of osteotomy site. Many practitioners are now using a transverse metaphyseal osteotomy; however, the authors choose the pivotal metaphyseal osteotomy as the procedure of choice using a 10- or 12-mm Pivotal Osteotomy Blade attached to an oscillating power source.

Humans