Congenital eversion of the upper eyelid: a case report.

Congenital ectropion of the upper lid is a rare condition that, if treated early, can be managed without recourse to surgery. We report a case in which an initial attempt at treatment with a pressure bandage failed, leading to a rapid worsening of the condition. A subsequent attempt at repositioning led to a respiratory arrest. Successful resolution occurred after taping of the lid. The case illustrates the need for early successful repositioning to break a cycle leading to increasing lid oedema; it also illustrates the importance of vigilance to the autonomic effects of lid manipulations in neonates.

Blastocystis hominis infection and intestinal injury.

Blastocystis hominis is an enteric protozoan associated with clinical illness. To determine the prevalence of intestinal injury in patients with B. hominis infection, the authors prospectively evaluated 18 patients with B. hominis infection by endoscopy and a test of intestinal permeability. Seventeen patients had gastrointestinal symptoms. Colonic mucosa appeared normal by lower endoscopy in 12 of 13 patients, and was friable slightly in 1. Duodenal mucosa was normal by upper endoscopy in nine patients. Pathologic examination of mucosal biopsy specimens did not demonstrate evidence of mucosal invasion. 51Cr-edetic acid (51Cr-EDTA) was given to the 18 patients with stools positive for B. hominis and to 32 healthy control subjects. Approximately 100 uCi of 51Cr-EDTA was given orally after an overnight fast, and urine was collected for the following 24 hours. Mean 24-hour urinary excretion of 51Cr-EDTA, calculated as a percent of the administered dose, was 1.31% (0.34-2.76%) in patients with B. hominis infection and 1.99% (0.59-3.48%) in the control subjects. The intestinal permeability to 51Cr-EDTA in blastocystis-infected individuals was not increased, but was decreased significantly compared with healthy subjects (p < 0.005). Therefore, in a group of symptomatic patients with B. hominis infection, endoscopy typically did not show evidence of significant intestinal inflammation, and results of intestinal permeability testing with 51Cr-EDTA did not suggest impaired barrier function of the intestinal mucosa. The clinical literature on B. hominis infection and intestinal injury is reviewed.

Intestinal permeability to [51Cr]EDTA in infectious diarrhea.

Orally administered [51Cr]EDTA was used to measure intestinal permeability in subjects with infectious diarrhea and in those without gastrointestinal complaints. [51Cr]EDTA was given to 87 subjects: 63 controls (32 normal controls, and 31 disease controls), and 24 patients with infectious diarrhea. Approximately 100 microCi of [51Cr]EDTA was given orally after an overnight fast. Urine was collected for the following 24 hr. Intestinal permeability to [51Cr]EDTA in both normal volunteers and in patients with a variety of diseases not associated with intestinal injury was low and results were in a relatively narrow range. Mean 24-hr urinary excretion of [51Cr]EDTA, calculated as a percent of the administered dose, in controls was 1.6% (0.2-3.5%). Patients with infectious diarrhea associated with invasive pathogens and/or intestinal inflammation had increased excretion of [51Cr]EDTA (mean 6.1%, P < 0.0001), with elevated excretions in 75%. These results demonstrate that intestinal infections must be considered as possible causes for increased intestinal permeability as assessed by the [51Cr]EDTA test.

Convergence insufficiency in thyroid eye disease.

The incidence of convergence insufficiency in patients with thyroid ophthalmopathy and their response to convergence exercise is unknown. Twenty-seven consecutive patients with thyroid eye disease (TED) were evaluated prospectively. Six patients with symptomatic convergence insufficiency obtained varying degrees of subjective and objective benefit from treatment. None of the six had other TED-related complaints that required therapeutic intervention. The study findings should alert the clinician to consider convergence insufficiency in patients with TED and nonspecific ophthalmic symptoms.

Generation of an osmolality gap-ethanol nomogram from routine laboratory data.

STUDY OBJECTIVES: To develop a practical procedure for producing a nomogram describing the relationship between the osmolality gap and serum ethanol concentrations that is appropriate for the formulas and analytical methodologies in use at any laboratory. DESIGN: Retrospective review of serum sodium, glucose, urea nitrogen, ethanol, and osmolality values and the use of spreadsheet software in the generation of a nomogram. SETTING: Emergency department in a university-affiliated county hospital. PARTICIPANTS: Two hundred three adult patients presenting with signs of alcohol intoxication. MAIN RESULTS: When either a common criterion (gap [mosmol/kg H2O] = ethanol [mmol/L]; range, -10 to +10) or a published nomogram was used for determination of consistency of the osmolality gap with the ethanol level, large percentiles of data were classified as inconsistent. Regression analysis and the method of truncated normal distributions were used to prepare a nomogram that better represented the data collected with our formulas and analytical methodologies. CONCLUSION: Interlaboratory analytical bias and the choice of the formula used for calculated osmolality limit the utility of published formulas or nomograms for the assessment of excess osmolality gap. Any laboratory can produce their own nomogram from routine patient data using the described spreadsheet procedure, without the need for measurement of volatiles other than ethanol.

The use of fibrin glue in mucous membrane grafting of the fornix.

We report using a fibrin-glue tissue adhesive in place of sutures to place a full-thickness mucosal graft into a defect created in a scarred fornix of an ophthalmic socket. This technique minimizes tissue trauma and aids hemostasis and healing.

Gas chromatographic headspace analysis of sevoflurane in blood.

We have developed a rapid, simple and precise gas chromatographic headspace analysis for sevoflurane in blood which circumvents problems associated with the high volatility and low blood/gas partition coefficient of this anesthetic drug. Blood standards are easily prepared by volumetric addition of a saturated aqueous solution of sevoflurane. Likewise, internal standardization is achieved using a saturated aqueous solution of halothane. Chromatographic conditions are similar to those commonly used for the analysis of blood ethanol. A simple method is also described for the preparation of stable and precise, aliquots of quality control materials for this assay.

The use of Q-switched Nd:Yag laser for removal of permanent eyeliner tattoo.

We present the results of a pilot study of the use of Nd:Yag laser in the removal of permanent eyeliner tattoos. Fourteen eyelids were treated, and in all cases a reduction in pigmentation was achieved although responses were variable. The advantages of such therapy over existing techniques are described. The technique offers a useful reduction of permanent eyeliner pigmentation and is particularly suited to treatment of localized areas of imperfect application or pigment migration.

How to perform a temporal artery biopsy.

Temporal artery biopsy is performed to confirm the diagnosis of giant cell arteritis. The technique is described together with the anatomy of the superficial temporal artery.

Antiphospholipid antibodies in the aetiology of ischaemic optic neuropathy.

The involvement of antiphospholipid antibodies in the mediation of acute anterior ischaemic optic neuropathy (AION) was studied, in the light of recent associations between these autoantibodies and other vascular events. A strong association between IgG anticardiolipin antibodies and AION secondary to biopsy proven giant cell arteritis was identified, which did not exist with the 'non-arteritic', biopsy negative form of AION. The possible implications of this finding on the aetiology, diagnosis, and treatment of giant cell arteritis are discussed.

Ocular involvement in giant cell arteritis.

Giant cell arteritis (GCA) is a systemic disease with a wide spectrum of clinical manifestations. Severe visual loss is the most frequent serious complication. This article reviews current ideas about GCA and in particular its ocular manifestations.