Biomedical subjects
Publications and source records attributed to Stela Giuri.
This is to show the case of a 40 year old patient, where a congenital retinal macro-vessel was found, the peculiarities of which are increased calibre, intersection of the macular area, arteriovenous shunts and lack of functional disturbances. The disease is rare and its lesional and functional stability is remarkable.
This is the description of the case of a 36 year old male, who developed a combined hamartoma of the pigment epithelium and retina in the left eye. The location of the lesion in the macular zone, as well as the peculiar aspect of disease, raised some issues related to differential diagnosis. Attention was paid to the diseases of the posterior pole of eyeball, which, given their aspect of disease, result of a secondary hyperplastic reaction of the EPR, can embody a type of combined pseudohamartoma: retraction syndrome, retinal angiomatosis, pseudohistoplasmosis and others. A 5 years clinical supervision of the patient didn't show major changes.
There are described a number of 9 clinical cases with unilateral myelinated nerve fibers, associated with myopia or amblyopia. Four cases developed extended myelinated areas, anisometropia with increased values, accentuated amblyopia and macular changes. Patients underwent treatment for amblyopia through correction with spectacles lenses and the occlusion of the congenerous eye. The obtained functional results differentiated the casemix in two groups: with therapeutic failure, 4 cases, characterized by extended myelination, anisometropia with an average of over -10 diopters and macular changes. with therapeutic success, 5 cases, characterized by reduced myelination, anisometropia with an average of over -4 diopters and normal maculae. It has been found a significantly statistical difference between the two groups as regarding the value of the anisometropia. However, the macular aspect has been an important factor in order the therapeutic effect to succeed. This clinical syndrome is differentiated from the unilateral simple myopia with amblyopia and from the myelinated nerve fibers without myopia or amblyopia.
Ophthalmologic surgical interventions are performed in numerous cases under general anaesthesia with halothane, many of which requiring a preoperatory mydriasis. Neosinerfin is alpha-adrenoceptive sympathomimetic. Local use, in a 10% concentration produces a strong mydriasis, resistant to the opening of the aqueous chamber during the intervention. Its systemic effects are remarkable: it induces a peripheral blood vessel constriction which can unleash a reflex bradycardia followed by a shortcoming of the cardiac flow. The halothane has various effects upon the heart: reduces the cardiac frequency, reduces the conduction speed of the cardiac impulse stimulating rhythm disorders, sensitizes the myocardium to the action of adrenaline, diminishes the heart's contraction force and the cardiac flow. The cumulative effects of seosinefrin and halothane cause major cardio-vascular changes: sinus bradycardia, ventricular arrhythmia, arterial hypotension. These are reasons for which the pre- and intraoperatory use of neosinefrin is unadvisable. Under this circumstances the collaboration between the ophthalmologist and anesthesiologist is very important, each of them having specific tasks. The ophthalmologist: preoperatory, the optimal pupillary dilatation may be obtained with tropicamide and diclofenac 0.1%, preoperatory, if the general anesthesia must be combined with local anesthesia, anesthetics in association with adrenalin should not be used; immediately postoperatory local use of atropine should be applied with cautiousness. The anesthesiologist: preoperatory he will not interrupt anti-hypertensive, anti-arrhythmia, anti-angina medication, with the mention that adrenoceptive alpha blockers (Prazosin) are indicated in comparison to adrenoceptive beta blockers because they diminish the risk of rhythm disorders; the use of clonidine and avoiding of phenobarbital in the premedication of the patient. As far as it is possible, it is recommended that halothane is replaced with izofluran or enfluran or enfluran which have a great tolerance to exogenous adrenoceptives.