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PubMedDate not supplied

[Central hemodynamics in conditions of combined intravenous anesthesia using propofol and ketamine in pediatric ophthalmology].

A total of 152 patients aged 4-14 years at risk of ASA I or II were examined. Planned operations were carried out: correction of myopia, strabismus, and eyelid ptosis. The patients were divided into 4 groups: 1) 54 patients operated on under combined anesthesia (propofol infusion and ketamine bolus), 2) 60 children operated on under combined anesthesia by ketamine and propofol infusions, 3) 24 patients operated on under ketamine + seduxene infusion narcosis, and 4) 34 children in whom ketamine and seduxen were injected in boluses. All operations were carried out under conditions of spontaneous respiration. Central hemodynamic parameters were studied by tetrapolar chest rheography with NCCOM3-R7 device (BIOMED). Methods of combined anesthesia with diprivan (propofol) are indicated for children subjected to ophthalmological surgery as methods with the minimum effects on the hemodynamics and ensuring adequate anesthesiological protection as regards the clinical and hemodynamic status.

Adolescent↗

PubMed2001

Pulmonary functions in ARC-welders in Ile-Ife, Nigeria.

OBJECTIVE: To investigate the occupational effects of Arc-welding on small scale welders in Modakeke, Ile-Ife, Nigeria. DESIGN: A community-based, cross-sectional study. SETTING: A semi-urban area Modakeke, Ile-Ife, Nigeria. POPULATION: A semi-urban area with a population of about 300,000 (three hundred thousand). STUDY POPULATION: Forty four Arc-welders in Modakeke, Ile-Ife and fifty age and sex-matched controls working in the Maintenance Department of Obafemi Awolowo University, Ile-Ife, Nigeria. INTERVENTION: Structured questionnaires adapted from the Medical Research Council, UK respiratory questionnaire with some modifications were administered to all subjects and controls. Physical examination and lung function tests were also carried out on all subjects and controls. MAIN OUTCOME MEASURES: Occupational-related symptoms of welders and controls were compared. Ventilatory function of welders and controls were also compared using the Student's 't'-test. Chi-square was adopted to test the strength of relationship between smoking and lung function abnormalities. RESULTS: The most frequent symptoms found among the subjects were eye irritation (95.43%), rhinitis (50.09%) and skin irritation (43.19%). The arc-welders were found to have characteristically lower lung function parameters than controls (p < 0.05). Ten (22.7%) of the subjects had obstructive lung disease compared to four (8%) of the controls; while 18 (40.9%) of the subjects had restrictive lung disease. Their lung abnormalities had no relationship to their smoking history. CONCLUSION: Workers exposed to arc-welding are at risk of occupational-related symptoms and chronic lung disease. Adoption of protective devices and monitoring of welders' breathing zones for toxic levels of gases and fumes are necessary to reduce the risk associated with arc-welding.

Adolescent↗

PubMed1995

The use of a foam anesthesia donut for the positioning of a patient in the barber chair position.

The foam anesthesia donut proves quite useful in the positioning of the patient in the barber chair position. By placing the donut on top of the patient's face, it protects the patient's eyes from trauma by the assistants holding retractors. The endotracheal tube also can be secured to the ring, protecting it from disconnection during surgery. The inner foam of the donut, which is removed when applying to the face, also can be used to pad the ulnar nerve at the elbow.

Anesthesiology↗

PubMed2004

Dose reduction to radiosensitive tissues in CT. Do commercially available shields meet the users' needs?

AIM: To assess the effectiveness and economy of routinely using commercially available in-plane bismuth shielding during CT scanning of the chest and brain. METHODS AND MATERIALS: Forty patients were scanned with thermoluminescent dosemeters (TLDs) in situ to measure the radiation dose to the thyroid and eye during CT scanning of the brain and chest. Half of the patients had the "AttenuRad" shield in place during scanning. RESULTS: Use of the shielding reduced the mean dose to the eye from 6.0 +/- 0.3 mGy to 4.9 mGy +/- 0.2 mGy and the thyroid dose from 16.4 mGy +/- 1.2 mGy to 7.1 mGy +/- 0.5 mGy. CONCLUSION: Use of the thyroid shield is recommended for all CT scanning of the chest. The eye shield does not produce as marked a reduction in radiation dose to the lens of the eye, when an angled gantry is used, since the eyes are not in the primary beam. Use of the eyeshield is justifiable where irradiation of the orbit is unavoidable, although whether artifacts would be a problem if the shield was used in this way was not assessed.

Dose-Response Relationship, Radiation↗

PubMed1996

Correction of subtle refractive error in aviators.

Optimal visual acuity is a requirement for piloting aircraft in military and civilian settings. While acuity can be corrected with glasses, spectacle wear can limit or even prohibit use of certain devices such as night vision goggles, helmet mounted displays, and/or chemical protective masks. Although current Army policy is directed toward selection of pilots who do not require spectacle correction for acceptable vision, refractive error can become manifest over time, making optical correction necessary. In such cases, contact lenses have been used quite successfully. Another approach is to neglect small amounts of refractive error, provided that vision is at least 20/20 without correction. This report describes visual findings in an aviator who was fitted with a contact lens to correct moderate astigmatism in one eye, while the other eye, with lesser refractive error, was left uncorrected. Advanced methods of testing visual resolution, including high and low contrast visual acuity and small letter contrast sensitivity, were used to compare vision achieved with full spectacle correction to that attained with the habitual, contact lens correction. Although the patient was pleased with his habitual correction, vision was significantly better with full spectacle correction, particularly on the small letter contrast test. Implications of these findings are considered.

Adult↗

PubMed2001

Don the barriers.

Health care workers (HCWs) have many "barriers" at their disposal to protect them from risk of occupational exposures to bloodborne pathogens or communicable diseases. These barriers include the daily use of personal protective attire, such as gloves, gowns, masks, and eye protection; following appropriate isolation precautions; using work practice controls, such as safety needles; using preventive methods less frequently needed, such as vaccination against the hepatitis B virus, annual influenza vaccinations, and prompt reporting of occupational exposures. Proactive and consistent use of these barriers makes any health care environment a safer place to work.

Communicable Disease Control↗

PubMedDate not supplied

Use of pesticides and its impact on health of farmers in South India.

The relationship between extent of pesticide use and signs and symptoms of illnesses due to exposure was assessed in a cross-sectional survey of 631 farmers (537 men and 94 women) in South India. Responses to questionnaires showed that 433 farmers (68.6%) sprayed pesticides themselves and were thus directly exposed. More than 75% used moderately or highly hazardous pesticides; 88% used no protection while handling pesticides. About 50% of sprayers mixed different brands. Retailers were the source of information about pesticides for 56%. The farmers reported excessive sweating (36.5%), burning/stinging/itching of eyes (35.7%), dry/sore throat (25.5%), and excessive salivation (14.1%), all more prevalent among sprayers. Among men, excessive sweating and eye and throat problems were significantly associated with exposure. There is a need to raise farmers' and authorities' awareness of the need to use protective gear when handling pesticides.

Adult↗

PubMed1998

A study of patterns and prevention of blood exposures in OR personnel.

The authors conducted a surveillance study of occupational blood exposures in the ORs at six hospitals to identify risk patterns and prevention strategies. For 15 months, trained circulating nurses recorded OR staff members' exposures during all surgical procedures using a modified version of the Exposure Prevention Information Network surveillance system. It was discovered that a high proportion of percutaneous injuries were potentially preventable if safer devices had been used, and the authors estimate that use of blunt suture needles alone could reduce injuries by 30%. Increased use of barrier precautions is indicated to prevent mucocutaneous blood exposures. Health care workers' eyes were identified in the study as being the most vulnerable location for serious blood exposures.

Blood-Borne Pathogens↗

PubMed1994

Performance decrement due to altered vision while wearing a respiratory face mask.

The purpose of this investigation was to determine performance decrement due to altered vision while wearing a respiratory face mask. Lenses clouded to visual acuities of 20/64, 20/38, 20/34, 20/28, 20/23, 20/20, and 20/15 were applied to each mask while subjects performed a battery of vision tests involving tracking and hand-eye coordination skills. Generally, performance decrement followed a significant curvilinear pattern as visual acuity worsened. These findings warrant the need to investigate the transfer of this performance decrement to skills that are inherent to military-type tasks.

Adolescent↗

PubMed1993

Melanized poly(HEMA) hydrogels: basic research and potential use.

Synthetic melanogenesis, using epinephrine and other melanin precursors, within the matrix of hydrophilic polymers and copolymers of 2-hydroxyethyl methacrylate resulted in hydrogels able to absorb ultraviolet and visible radiation. This significantly enhances their value as materials for extraocular (contact lenses) or intraocular (artificial crystalline lenses) devices that should protect the retina of aphakic patients from potential damage induced by light. The two-phase morphology of melanized hydrogels, as investigated by TEM, revealed a fine structure that is possibly indicative of a true sequential interpenetrating polymer network. Their biocompatibility was evaluated by a set of different assays involving human choroidal fibroblasts. No cytotoxicity was found in the aqueous extracts of materials. By using an assay with cells and polymers embedded in a collagen gel, a short-range toxic effect was detected, presumably caused by melanin itself. However, in vivo experiments in animal eyes with melanized hydrogel intraocular lenses did not reveal any toxic reaction.

Animals↗

PubMed2006

[Precautions in the care of patients hospitalized with H5N1 avian influenza].

Several agencies have proposed infection control guidelines for management of patients admitted with the diagnosis of avian influenza. These guidelines aim to prevent transmission from the patient to hospital personnel and other inpatients. The guidelines presented here by the Advisory Committee of Nosocomial Infections have been elaborated for the local medical community after reviewing currently available recommendations. Key recommendations include admission to an isolation ward, cohorting of confirmed cases, hand hygiene with antiseptic solutions, use of N95 type masks, non-sterile disposable gloves and eye protection equipment during examination or when performing aerosols-generating procedures. Use of patient-exclusive clinical instruments, daily disinfection of the hospital ward, implementation of measures to reduce risk of needle stick injuries and eye splashing, and reinforcement of appropriate sampling and transport of blood and other corporal fluids, are also recommended.

Cross Infection↗

PubMed1982

Improved radiation protection for physicians performing cardiac catheterization.

Physicians and their assistants performing diagnostic angiography must be concerned with the radiation exposure they receive. The introduction of hemiaxial projections for imaging has increased diagnostic accuracy but has also greatly increased the physicians' exposure to scattered radiation. This increase is especially critical for the eyes and thyroid of the physician who routinely performs these procedures. To reduce such exposure a ceiling-suspended shield (60 x 45 cm), made of 6.4 mm glass with a 19.5 kg/m2 (4 lb/ft2) lead equivalency, was developed. During procedures the shield is interposed between the physician and the region of the patient acting as the source of scattered radiation. The degree of radiation protection to the operator was assessed by measuring the distribution of scattered radiation in the vicinity of the operator with and without the shield. The effectiveness of the shield was determined in the 30 degrees right anterior oblique (RAO), 5 degrees left anterior oblique (LAO), 35 degrees LAO, and 50 degrees LAO-15 degrees cranial angulations. At critical heights such as the level of the eyes and thyroid, scattered radiation levels were reduced by 85% or greater in all angulations. Without interfering with the physician's ability to observe the patient or manipulate the catheter, this shield can significantly reduce the physician's exposure to radiation.

Angiocardiography↗

PubMedDate not supplied

An objective determination of +Gz acceleration tolerance.

Until recently, human +Gz acceleration tolerance has relied solely on subjective criteria relating to loss of vision. By use of newly developed noninvasive instrumentation using a transcutaneous Doppler flow system, objective end point criteria have been developed based on measured blood flow to the head. The system consists of miniature 8 MHz Doppler sensors (2 x 1 x 0.5 cm) placed on the forehead over both frontal branches of the temporal arteries to detect blood flow velocity from back scattered ultrasound. Its use has allowed for correlation of altered, decreased and actual reversal of eye level blood flow with subsequent central light loss. Over 100 subjects have now been studied during more than 2,000 centrifuge runs. Objective changes in temporal artery flow velocity consistently preceded visual degradation for each subject during all acceleration profiles. No subject has gone unconscious without first exhibiting a minimum 6 sec of total flow cessation. Retrograde flow followed by complete flow cessation always preceded central light loss. Results indicate that this method can be successfully used with a wide variety of tasks during exposure to +Gz acceleration. It is recommended for use during evaluation of protective maneuvers or devices on the centrifuge or during actual flight in high performance aircraft. It may also serve as a potential safety monitor during space Shuttle re-entry if there is doubt about a passenger's cardiovascular status.

Acceleration↗

PubMed1984

[Laser radiation protection in medicine].

In medicine, lasers with different wave lengths are applied for therapeutic purposes. The human eye is especially endangered by laser rays with a wave length between 400 and 1400 nm. This is due to the fact that these laser rays are focused in the retina by the refracting media of the eye, so that the energy dose is considerably increased. If these lesions are situated in the most sensitive point of the retina, this may cause a markedly deteriorated vision. The necessary protective measures in the use of laser rays are based on a classification of lasers in four degrees according to the risk involved. The essential measures of protection are a shielding by filters, protective glasses and the determination of a so-called laser zone.

Germany, West↗

PubMed1992

[Studies on radiation exposure of personnel in endoscopy].

Some endoscopic investigations and treatments require the use of x-ray equipment. There is no specific x-ray device for endoscopic procedures. Standard x-ray apparatus is used, which is designed to give optimal protection against radiation at the standard location of the radiologist. However during special endoscopic examinations nurses and doctors are located at parts of the x-ray apparatus which are not specially protected from x-rays. For this reason measurements were performed during endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic cholangiography (PTC) and schlerotherapy at those positions, where nurses and doctors are standing or sitting during these procedures. The measurements show that at the position of the radiologist there is practically no radiation detectible. However the hands, legs and the face (eye lenses) of the assisting nurse receive relatively high radiation. The values amount to 30% of the allowed maximum. By relatively simple appliances like lead lining around the lower bottom part of the x-ray apparatus or a lead apron lowered from the ceiling between head and body of the patient the radiation load can be significantly lowered to 1% of the maximal allowed radiation. With such simple additional protection frequencies and duration of x-ray related endoscopic investigations can be extended without danger for the staff.

Cholangiography↗

PubMed2005

Angioplasty and stenting of the cervical carotid bifurcation under filter protection: a prospective study in a series of 53 patients.

The aim of this study is to assess safety, reliability, ease of use and usefulness of filter protection devices during angioplasty and stenting of stenotic lesions of the cervical carotid bifurcation. Over a period of 42 months, 53 patients harboring a cervical carotid bifurcation stenotic lesion were treated, by angioplasty and/or stenting using filter protection devices of different kinds. The stenosis was atherosclerotic in 48 cases, post-surgical in four and post-radiation in one case. In all cases, the treatment was successful, with good restoration of the luminal diameter. There were three major strokes (5.6%) and one minor stroke (1.9%). Two of these (one major, one minor) occurred a few hours after the stenting procedure and both seemed by all evidence due to a hemorrhagic hyperperfusion syndrome. One hemiparesis and dysphasia occurred two days after the procedure, secondary to subacute thrombosis with occlusion of the stent. One patient complained of three episodes of decrease in visual acuity of the eye ipsilateral to the stenting in the two weeks following treatment. In conclusion, in our experience, use of the devices adds only few minutes to the procedure time; direct lesions of the arterial wall, such as dissections or intraluminal thrombi, related to the use of filters were never observed, and spasm of the distal I.C.A. also proved rapidly regressive. The content of all filters, if any, was histologically examined, but plaque material was found only in one case, probably owing to our primary stenting technique without use of pre-dilation. The major technical drawback is in-filter coagulation, which occurred in 16 cases, occluding the membrane of the filter and thus slowing or blocking intracranial flow. Such an event can be counteracted by a more aggressive anti-coagulation protocol, which could, however, be responsible for the two complications with hemorrhagic brain infarction. Furthermore, we observed two other major neurological events, which bring the incidence of neurological complications in this series as high as 7.5%. Therefore, it is our opinion that safety of filters is not yet proven, and consequently great care must be taken in their use.

Aged↗

PubMedDate not supplied

Reducing blood and body fluid exposures among clinical laboratory workers. Meeting the OSHA standards.

This article examines risks and exposure patterns in clinical laboratories to help identify the most effective methods for implementing the OSHA standard for protection against bloodborne pathogens, especially hepatitis B virus and the human immunodeficiency virus. Using eye-opening figures, tables, and statistics, the authors identify areas where clinical laboratorians can improve their protection and conclude by offering three strategies for reducing blood and body fluid exposures in clinical laboratories.

Acquired Immunodeficiency Syndrome↗

PubMed2005

Deep lamellar keratoplasty (DLKP) in keratoconus patients using viscoadaptive viscoelastics.

PURPOSE: To demonstrate the effectiveness and safety of using viscoadaptive viscoelastics in deep lamellar keratoplasty (DLKP) for keratoconus. METHODS: A nonrandomized, comparative, interventional case series was performed on 12 eyes of 10 consecutive keratoconus patients without a history of acute hydrops. Patients were treated with DLKP using ophthalmic viscosurgical devices (OVDs) to dissociate Descemet membrane (DM) from the stroma before suturing of the donor cornea. Eight eyes were operated using Viscoat (dispersive), and 4 eyes were operated using Healon V (viscoadaptive). RESULTS: Six out of 8 eyes in the Viscoat group were successfully treated, and 2 eyes were converted to PKP because of tears in the DM. Another 3 eyes had double chambers as a result of perforations or tears in DM, which were treated by injecting air into the anterior chamber. All 4 eyes in the Healon V group were successfully operated, with 1 case with microperforation of DM during suturing. Healon V offered better control of the area to be dissociated and served as a pseudostroma that protects the exposed DM while the overlying stroma is maneuvered. CONCLUSION: Healon V is a valuable tool for performing DLKP in difficult cases such as keratoconus.

Adult↗