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Biomedical subjects

W E Scott

Publications and source records attributed to W E Scott.

At least 55 records · Page 3Linked to original sources
PubMed1989

Management of monocular congenital cataracts.

From 1971 through 1985, a diagnosis of monocular congenital cataract was made in 14 consecutive patients. All patients had a visually significant cataract that was documented at birth or within 2 months of age. All patients were followed up long enough to report distance linear recognition acuity. Excellent visual acuity (V/A) correlated with earlier surgery, earlier contact lens fit, and excellent amblyopia therapy compliance. The oldest age for attainment of excellent or good V/A was 17 weeks. Patching therapy was based on the binocular fixation pattern. The patching program consisted of 50% occlusion until the age of 2 months and gradually increased to 100% occlusion after the age of 7 months. Six patients (43%) attained excellent V/A (greater than 20/50), with three patients (21%) attaining good V/A (20/60 to 20/100) and five patients attaining poor V/A (less than 20/100).

Cataract↗
PubMed1989

The answer to "What are my chances, doctor?" depends on whom is asked: prognostic disagreement and inaccuracy for critically ill patients.

Physicians often must make prognostic judgments for critically ill patients, but we know little about how well they can perform this task. We prospectively measured disagreements among different physicians' quantitative prognostic judgments for 269 sequential admissions to an ICU, and evaluated the accuracy and discriminating ability of judgments made by different types of physicians. Many (44.7%) patients provoked one or more disagreements of at least 20 percentage points among the three possible pairings of physicians. Many patients whom one physician thought were certain to survive did not inspire such certainty in another of their doctors. The critical care attendings thought the changes of survival were less than or equal to 80% for 23, and between 81% and 95% for another 46 of 85 patients whom the patients' own attendings thought were certain to survive. There were some differences in the accuracy of the different physicians' estimates. All doctors showed excellent overall discriminating ability, but discriminated less well for postoperative patients. Lack of consensus about how to judge prognosis for critically ill patients may make it difficult to decide whom to admit to ICUs. These results underscore the need for valid predictive models to aid in decision-making for critically ill patients.

Adult↗
PubMed1989

Management and visual acuity results of monocular congenital cataracts and persistent hyperplastic primary vitreous.

Sixty-two patients, 48 with a diagnosis of persistent hyperplastic primary vitreous (PHPV) and 14 with monocular congenital cataract (MCC) are reported. Nineteen patients with a diagnosis of PHPV and all patients with MCC received surgery with attempted visual rehabilitation. Early age of surgery, prompt optical correction with contact lens and aggressive patching therapy are required for successful visual rehabilitation. Glaucoma, retinal or optic nerve pathology, surgery later than three months of age or combinations of these factors were associated with poor prognosis. Isolated microphthalmos was not correlated with poor prognosis. Binocular fixation pattern was used to monitor patching therapy. Optokinetic nystagmus, visual evoked potentials or forced preferential looking were not employed. Of the 33 patients who underwent surgery, 10 (30%) achieved good (greater than or equal to 20/50) visual acuity, 8 (24%) achieved fair (20/60 to 20/100) and 15 (46%) achieved poor vision. In selected patients with the diagnosis of PHPV or MCC, visual rehabilitation can be achieved.

Age Factors↗
PubMed1989

Vertical offsets of horizontal recti muscles in the management of A and V pattern strabismus.

Vertical transposition of the horizontal rectus muscles is the preferred operation in cases of A and V pattern strabismus in which oblique muscle dysfunction is inadequate to merit oblique surgery. Fifty-nine patients undergoing standard horizontal surgery with half tendon width vertical offsets and eight patients undergoing two-thirds to full tendon width offsets were retrospectively studied. Technique for pattern measurement and surgery are discussed. Postoperative data were analysed on a short-term (less than six weeks) and long-term (greater than 12 months) basis. Standard horizontal surgery combined with half-tendon width vertical transposition is shown to be an effective operation for collapsing all subgroups of A and V pattern strabismus when indications are appropriate. The initial correction to within +/- 10 D of pattern was 96% over all with 78% remaining collapsed to within +/- 10 D over an average 36-month follow-up. Recess-resect, bimedial and bilateral rectus recession operations with offsets are all approximately equally effective in pattern collapse. A graded pattern collapse response was found with greater collapse being related to greater initial pattern. The risk of conversion, from a more desirable pattern (AET, VXT) to a less desirable pattern (AXT, VET) is low (7.3%). For patterns greater than 30 D, three quarters to full-tendon width offsets were effective in collapsing pattern. For A and V patterns with significant oblique muscle dysfunction, oblique surgery is advocated.

Follow-Up Studies↗
PubMed1988

Stability of visual acuity in amblyopic patients after visual maturity.

One hundred thirty patients with strabismic amblyopia who underwent full-time occlusion therapy (FTO) and were followed through to at least 9 years of age were evaluated to determine the stability of visual acuity after visual maturity (after 9 years of age). Of these 130 patients, 89 are included in this review. At the conclusion of the FTO therapy, 92% (82/89) had attained a visual acuity of 20/40 or better, 6% (5/89) had attained 20/50-20/100, and 2% (2/89) remained at 20/200 or less. Of the nine patients in this series in whom patching was initiated between the ages of 6 and 9 years of age, a good visual result was seen in 89% (8/9), with 63% (5/8) of those attaining 20/20 vision. The final visual acuity in this group of patients was taken at an average patient age of 15.9 years. In 75% of the patients (67/89) there was no change in visual acuity over time, while 17% (15/89) showed a one- or two-line decrease, and in 8% (7/89) vision dropped more than two lines. Of those patients who had greater than or equal to 20/40, 88% (56/64) who had a posttreatment visual acuity of 20/20 showed no change at the final evaluation, but only 50% (9/18) of those whose posttreatment vision was between 20/25 and 20/40 were stable. In those patients who needed part-time occlusion (PTO) to maintain equal visual acuity, their stability appeared to be the same as the vision of those whose vision was maintained without PTO.

Adolescent↗
PubMed1988

Reimbursement for intensive care services under diagnosis-related groups.

Current governmental policy, in an effort to reduce the federal deficit, has switched to a prospective payment system for hospital care of Medicare patients based on Diagnosis-Related Groups (DRGs). In New Jersey, all hospital care is reimbursed using a DRG system. This study examines the relationship between charges and reimbursement in a university hospital ICU under a DRG system for the care of patients who consume a large amount of the ICU resources. For patients who were classified Class IV under the Therapeutic Intervention Scoring System, with the possible exception of open heart patients, the charges for care delivered exceeded income received, with a net revenue of -$24,098 and an adjusted net revenue of -$5,057 for ICU Class IV patients (excluding open hearts). Thus, it appears that the care given to these patients may have resulted in a financial loss to the institution. If this were to continue, the financial impact might have a negative effect upon attempts to regionalize intensive care services.

Critical Care↗
PubMed1986

Surgery for large-angle congenital esotropia. Two vs three and four horizontal muscles.

Large-angle congenital esotropia is usually managed surgically by either of two fundamentally different approaches: (1) the uniform approach, in which surgery is restricted to two extraocular muscles (bimedial recessions or monocular recession-resection), or (2) the selective approach, in which bimedial recessions are combined with resections of one or both lateral rectus muscles. We compared surgical results of the two types of surgery during a ten-year period for 107 patients, of whom 57 underwent bimedial recessions, two had monocular recession-resections, and 48 received three- or four-muscle surgery. The average follow-up time was 2.6 years. The percentage of good surgical results (orthophoria +/- 10 PD) in the selective group was 64.5%, compared with 37.3% in the uniform group. Only three of the 48 patients in the selective group required a second procedure, compared with 17 of 59 patients in the uniform group.

Child↗
PubMed1986

Visual acuity results following treatment of persistent hyperplastic primary vitreous.

The visual acuity outcome of patients with persistent hyperplastic primary vitreous (PHPV) was reviewed. A total of 48 patients with the diagnosis of PHPV were seen at the University of Iowa, Iowa City, from 1971 through 1984. Twenty-five patients were managed nonsurgically, of which 23 had a poor visual acuity outcome (less than or equal to 5/200). Two with mild cases had visual acuities of 20/100 and 20/30. Twenty-three patients were treated surgically. Five of these had no further postoperative rehabilitation. Eighteen patients underwent surgery and aggressive optical and occlusion therapy. Eight of these 18 patients (44%) had postoperative visual acuities of 20/200 or better. These eight patients represent 17% of the study population. Therefore, lensectomy-membranectomy procedures for the purpose of effecting visual development are reasonable therapeutic options in patients with PHPV in whom the findings are primarily anterior in nature, surgery is performed at an early age, and aggressive amblyopia therapy is instituted.

Amblyopia↗
PubMed1986

Surgical treatment of Duane's syndrome.

Nineteen patients undergoing treatment for Duane's syndrome are reported. The patients were treated with appropriate horizontal muscle recession in order to relieve abnormal head position or a significant tropia in primary position. Success rate in eliminating the abnormal head position was 79% while 100% were significantly improved. No overcorrections occurred despite large recessions. Retraction in adduction was reduced in each case. Motility of the eye was not increased following recession and in no case was fusion ability or stereopsis affected. The elimination of abnormal head position appears to be stable for periods up to 8.75 years. Postoperatively, patients obtained approximately 30 degrees of binocular visual field including primary position. Other surgical techniques in treating Duane's syndrome are discussed.

Adolescent↗
PubMed1986

Four-muscle surgery for infantile esotropia with V-pattern.

Inferior oblique overaction is frequently seen with infantile esotropia. In patients with infantile esotropia and V-pattern with moderate to large inferior oblique overactions, the oblique weakening can be combined with horizontal muscle surgery. Eighteen patients with infantile esotropia and V-pattern underwent bilateral inferior oblique recessions with bilateral 5.0-mm medial rectus recessions. Sixty-one patients with infantile esotropia underwent bilateral 5.0-mm medial rectus recessions alone. At 2 years' follow-up, the patients who had undergone medial rectus recessions alone showed, on average, 12.9 dioptres more reduction in esodeviation at distance and 13.4 dioptres more reduction at near in primary position than did those who had undergone 4-muscle surgery (P = 0.03). Only 2 of the 18 patients (11%) who had undergone 4-muscle surgery developed an A-pattern postoperatively.

Child↗
PubMed1985

Pursuit is impaired but the vestibulo-ocular reflex is normal in infantile strabismus.

To determine if infantile (congenital) strabismus is associated with a defect of ocular pursuit or vestibulo-ocular reflexes, eye movements were recorded in 14 subjects. Subjects with infantile strabismus had an impairment of temporally directed pursuit when monocularly viewing a moving target. They were unable to normally enhance or cancel the vestibulo-ocular reflex using visual tracking. Vestibulo-ocular reflexes were normal during rotation at 0.3 Hz in the dark. The pursuit defect was not found in subjects with noninfantile strabismus. We suggest that patients with infantile strabismus have a defect of cerebral pursuit control.

Child, Preschool↗
PubMed1985

Occult metoprolol overdose.

A patient with an apparent dilantin and phenobarbital overdose displayed hypotension and oliguria resistant to usual cardiotonic drugs and volume loading. In addition, she required an unusually high dose of epinephrine for resuscitation. Metoprolol, a beta-blocker not included on the drug screen, was subsequently implicated. An overdose of this drug should be suspected in patients whose hypotension is resistant to usually effective doses of inotropic and chronotropic agents.

Adult↗