Medical and surgical management of the small pupil during cataract surgery.

As cataract surgery continues to evolve, the intraoperative small pupil continues to pose challenges to even the most experienced cataract surgeon. Several steps can be taken preoperatively to decrease the chance of intraoperative miosis. Even so, the problem of miosis during cataract surgery remains a relatively common occurrence. This paper discusses many steps, both preoperative and intraoperative, that can make surgery technically easier and safer, thus maximizing the postoperative outcomes and patient satisfaction. Complications associated with small-pupil cataract surgery, risk factors for intraoperative miosis, the preoperative and intraoperative management of the small pupil during cataract surgery, and postoperative care are reviewed.

Head shape measurement standards and cranial orthoses in the treatment of infants with deformational plagiocephaly.

This review aims to determine how head shape is measured and describes the use of orthoses in the management of deformational plagiocephaly. A systematic review was conducted and papers published in English up to and including 2006 were sourced from nine databases. After initial screening, 20 papers were included; three literature reviews and 17 original papers. Of the original papers, eight concerned the method of head shape measurement. Measurements are important in determining clinical classification and treatment modality of deformational plagiocephaly. All studies were appraised and assigned a level of evidence according to the Scottish Intercollegiate Guidelines Network. Methodological quality was inadequate. Publications involving the use of cranial orthoses used convenience samples, were not blinded, and used different measurement techniques. No comparison groups were included and participants were not randomized. Evidence suggests that conservative treatments might reduce skull deformity although the quality is poor. Clinical studies investigating the use of cranial orthoses reported beneficial effects. Further research is required to identify the efficacy of cranial orthoses in the treatment of deformational plagiocephaly based on a standardized measurement technique to facilitate classification of this condition.

A qualitative assessment of Toxoplasma gondii risk in ready-to-eat smallgoods processing.

Toxoplasma gondii is one of the most common parasitic infections of humans and other warm-blooded animals. In most adults, it does not cause serious illness, but severe disease may result from infection in fetuses and immunocompromised people. Consumption of raw or undercooked meats has consistently been identified as an important source of exposure to T. gondii. Several studies indicate the potential failure to inactivate T. gondii in the processes of cured meat products, This article presents a qualitative risk-based assessment of the processing of ready-to-eat smallgoods, which include cooked or uncooked fermented meat, pâté, dried meat, slow cured meat, luncheon meat, and cooked muscle meat including ham and roast beef. The raw meat ingredients are rated with respect to their likelihood of containing T. gondii cysts and an adjustment is made based on whether all the meat from a particular source is frozen. Next, the effectiveness of common processing steps to inactivate T. gondii cysts is assessed, including addition of spices, nitrates, nitrites and salt, use of fermentation, smoking and heat treatment, and the time and temperature during maturation. It is concluded that processing steps that may be effective in the inactivation of T. gondii cysts include freezing, heat treatment, and cooking, and the interaction between salt concentration, maturation time, and temperature. The assessment is illustrated using a Microsoft Excel-based software tool that was developed to facilitate the easy assessment of four hypothetical smallgoods products.