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Biomedical subjects

W P Boger

Publications and source records attributed to W P Boger.

At least 19 recordsLinked to original sources
PubMed1984

Recurrent isolated sixth nerve palsy in children.

Six children had recurrent sixth nerve palsy the average duration of which was six weeks. One youngster, after several episodes of sixth nerve palsy, had residual esotropia and underwent strabismus surgery. The average interval between recurrences was 1.3 years. Ipsilateral recurrences were a prominent feature. Thus far the recurrences of palsy in this group of patients has not been associated with any identifiable intracranial process. Multiple recurrences in the absence of any recognizable febrile illness clearly suggests that not all "benign" sixth nerve palsies in children are due to postinfectious processes. The etiology of isolated benign sixth nerve palsy remains uncertain. Benign sixth nerve palsy with recurrence may account for a larger percentage of truly "isolated" palsies in otherwise healthy youngsters than has been generally appreciated since several widely quoted papers on this subject have included individuals with multiple neurologic deficits at the time of initial presentation. This report of recurrent palsies for which etiologies were not established should not diminish the concern that there might be an identifiable, serious, cause for sudden onset of sixth nerve palsy in a youngster. The diagnosis of "benign" sixth nerve palsy is one of exclusion that is made retrospectively and only after an adequate period of close observation.

Abducens Nerve↗
PubMed1983

Shortterm "escape" and longterm "drift." The dissipation effects of the beta adrenergic blocking agents.

The dissipation phenomena associated with timolol have important implications in the clinical management of glaucoma patients. Shortterm "escape" and longterm "drift" are clinical terms which describe the reduction of timolol's efficacy over a few days and over months and years, respectively. Recent physiological studies suggest a cellular explanation for these readjustments in tissue responsiveness to continued administration of timolol. While the precise location of the physiologically responding cells and the interactions of the various adrenergic responsive elements remain unclear, subsensitivity and supersensitivity may prove to be the most accurate designations for alterations in tissue responsiveness to adrenergic stimulation following "down regulation" or "up regulation" of beta receptor density on cell membranes.

Adrenergic beta-Antagonists↗
PubMed1983

Timolol in childhood glaucoma.

In determining the role of timolol in the treatment of childhood glaucoma, the difficulties of conducting investigational studies in children and the possible delayed appearance of longterm side effects are real concerns. However, an equally important consideration is the fact that young children may face a lifetime of blindness from uncontrolled glaucoma. Timolol is not always successful in lowering intraocular pressure on a longterm basis in severe glaucoma, but it often does help in managing extremely difficult cases. In some respects, the results of using timolol in children are consistent with those achieved with severe adult glaucoma. Although experience with children under one year of age is still extremely limited, theoretical considerations would suggest that children might be particularly vulnerable to the known systemic side effects following local absorption, as well as to longterm side effects that are yet unknown.

Age Factors↗
PubMed1981

Long-term drift and continued efficacy after multiyear timolol therapy.

The clinical courses of 41 patients who received timolol maleate for experimental protocols were reviewed. We reevaluated the conditions of 17 patients with the elevated pressures of primary open angle glaucoma who had received timolol alone or in combination with other glaucoma medications for a maximum of 35 months (average, 26 months). Withdrawal of timolol led to an average intraocular pressure rise of 5 mm Hg. Eight patients treated with timolol alone showed a progressive, significant, 3-mm Hg upward rise, or "long-term drift" in IOP during the follow-up period. Pressure rise after timolol withdrawal, however, was not significantly less than pressure reduction when timolol was initiated. At least two weeks are required for "washout" or disappearance of timolol effect after timolol is withdrawn, and re-treatment for one week restores IOP to prewithdrawal levels.

Acetazolamide↗
PubMed1981

Spontaneous absorption of the lens in the congenital rubella syndrome.

Seven eyes in five patients with the congenital rubella syndrome have shown partial or complete absorption of a cataractous lens without surgical intervention. The rare occurrence of spontaneous lens absorption should not be a reason for delaying the early removal of dense bilateral cataracts in this condition.

Adolescent↗
PubMed1981

Keratoconus and acute hydrops in mentally retarded patients with congenital rubella syndrome.

Four patients with the congenital rubella syndrome had keratoconus and evidence of acute or previous corneal hydrops. All four of the patients vigorously rubbed and poked their eyes. The keratoconus and acute corneal hydrops in these patients probably resulted from chronic traumatizing mannerisms common in other patients with mental retardation and are not specific for the congenital rubella syndrome.

Adolescent↗
PubMed1981

Optic atrophy and visual loss in craniometaphyseal dysplasia.

Four members of one family had craniometaphyseal dysplasia. Two of the four had severe optic atrophy with profound loss of vision as a complication of this disorder. Optic nerve decompression attempted in one patient may have caused a reduction in the vision of that eye. Eight years later this patient underwent craniofacial surgery uneventfully for contouring of her facial and cranial bones, but osteotomies and intracranial surgery were specifically avoided because of bony over-growth in the foramen magnum region.

Adolescent↗
PubMed1981

Timolol in uncontrolled childhood glaucomas.

Thirty-four patients with childhood glaucoma who had difficult management problems in spite of conventional glaucoma medications were entered into an investigational protocol designed at a time when timolol was not available commercially. Since controlled studies in adult glaucoma had demonstrated the efficacy of timolol, a trial of the drug in these difficult childhood cases seemed justified. The study was approved by the Human Studies Committees of the Children's Hospital Medical Center and the Massachusetts Eye and Ear Infirmary, Boston, MA. These children have been followed for periods up to 2 1/2 years. In general, timolol was added to the maximum tolerated medical therapy. Definite improvement was noted in 10 patients, modest or equivocal improvement in 11, and in 13 no substantial benefit to their course occurred when timolol was added. youngsters over 5 years of age showed an average reduction in resting pulse rate of 6 beats/minute similar to that previously found in adult patients. Under 5 years of age no change in the resting pulse rate could be detected. One patient was discontinued from timolol for a possible adverse effect. The experience particularly in very young children is still quite limited, but the beneficial effects observed warrant further evaluation.

Adolescent↗
PubMed1980

Late ocular complications in congenital rubella syndrome.

Ocular consequences of the congenital rubella syndrome are not limited to abnormalities noted in the neonatal period. Additional abnormalities may appear years and even decades after birth. Thirteen patients are presented in whom glaucoma has been diagnosed 3 to 22 years after birth. This acquired form of glaucoma has occurred in microphthalmic eyes in all but two cases. In all patients, the lens was cataractous early in life and had either been removed surgically or had been absorbed spontaneously. The diagnosis of late onset glaucoma appears to be difficult to make and is often overlooked. A smaller but overlapping group of patients with congenital rubella syndrome had keratic precipitates without other evidence of acute ocular inflammation. Recognition of these late ocular complications is particularly relevant, since the affected youngsters born during the last major US rubella epidemic in the early 1960s are now reaching late adolescence.

Adolescent↗
PubMed1979

The treatment of glaucoma: role of beta-blocking agents.

The sudden development of a red painful eye with blurred vision may be an acute attack of angle closure glaucoma which requires emergency attention. Once the attack is controlled with medication, surgical intervention with a peripheral iridectomy is indicated to relieve relative pupillary block. Eyes subject to angle closure glaucoma are anatomically different with 'crowded' anterior segments. In contrast, open angle glaucoma (the more common form) may progress to near blindness without symptoms. Routine screening of intraocular pressure is, therefore, necessary to make the diagnosis before extensive irreparable damage has occurred. Surgery for open angle glaucoma carries risks of cataract and infection, and is unpredictable. Open angle glaucoma patients are usually treated chronically with specific medications. Beta-Adrenoceptor blocking agents appear to provide a significant new addition to the currently available antiglaucoma medications.

Administration, Topical↗
PubMed1978

Clinical trial comparing timolol ophthalmic solution to pilocarpine in open-angle glaucoma.

A ten-week, double-masked, randomized, clinical trial compared timolol ophthalmic solution and pilocarpine in the therapy of open-angle glaucoma. Timolol decreased the intraocular pressure at least as much as pilocarpine and did not induce miosis, accommodative spasm, or other annoying side effects. The pulse was slowed by timolol, but blood pressure was unaffected. Significant decreases in intraocular pressure were still present after ten weeks of maintenance therapy with the same concentration of drug.

Adult↗
PubMed1978

Phenylephrine provocative testing in the pigmentary dispersion syndrome.

Forty-nine patients with bilateral pigmentary dispersion syndrome (abnormal accumulation of pigment in the anterior chamber, principally from the posterior layers of the iris), including 31 patients with pigmentary glaucoma, underwent 10% phenylephrine testing in one eye for evaluation of liberation of pigment floaters into the anterior chamber and the influence of phenylephrine on the intraocular pressure. Ten patients with pigmentary glaucoma developed a 3+ to 4+ pigment response, but only two demonstrated a pressure rise greater than 2 mm Hg. The highest pressure rise observed was 7 mm Hg. Nine patients with pigmentary dispersion syndrome but without glaucoma also developed a 3+ to 4+ pigment response, but none of these had a pressure rise. The incidence of pigment liberation was higher in older patients and in pigmentary glaucoma patients receiving topical antiglaucoma therapy at the time of testing. The extent of iris transillumination did not correlate with the grade of phenylephrine-induced pigment liberation. Two pigmentary glaucoma patients, who did not liberate pigment or have a pressure rise when tested with phenylephrine, did exhibit spontaneous or exercise-induced liberations of pigment into the anterior chamber, with marked rises of intraocular pressure and obstruction of aqueous outflow.

Adult↗
PubMed1978

Long-term experience with timolol ophthalmic solution in patients with open-angle glaucoma.

Timolol was used by 37 glaucoma patients from 1 to 18 months. Of those 37 patients, 31 used timolol for three months or longer and 7 used timolol for over one year. Timolol produced sustained reductions in intraocular pressure with continuous administration and did not induce miosis, accommodative spasm, or other annoying side effects. Systemic absorption produced a mild slowing of resting pulse rate. In some patients, timolol's ocular hypotensive effects are additive to miotics and carbonic anhydrase inhibitors.

Adult↗
PubMed1978

Psychotropic drugs, summer heat and humidity, and hyperpyrexia: a danger restated.

The authors note an apparent unawareness of, as well as a paucity of recent literature pertaining to, hyperpyrexia as a complication of psychotropic drug treatment. They report a case of hyperpyrexia in a patient receiving psychotropic agents during a summer heat wave; massive muscle destruction (rhabdomyolysis) with myoglobinuria and acute renal failure make this case of particular interest. Causative mechanisms, preventive measures, and the benefits of prompt recognition and treatment of this condition are discussed.

Antipsychotic Agents↗