Interventions for idiopathic intracranial hypertension.

BACKGROUND: Idiopathic intracranial hypertension occurs throughout the world with an estimated incidence of one to three per 100,000 population per year. It occurs most commonly in obese young women but the cause is unknown. It presents a significant threat to sight and is associated with severe morbidity, in the form of headaches in most cases. Several different treatments have been proposed ranging from relatively conservative measures such as diuretic therapy to more invasive treatments such as optic nerve sheath fenestration, stenting of cerebral venous sinuses, or lumbo-peritoneal shunting. OBJECTIVES: The objective of this review was to assess the effects of various forms of treatment for idiopathic intracranial hypertension with a view to producing an evidence-based treatment strategy. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), which contains the Cochrane Eyes and Vision Group Trials Register, on The Cochrane Library (Issue 4, 2004), MEDLINE (1966 to January 2005) and EMBASE (1980 to January 2005). SELECTION CRITERIA: We included only randomised controlled trials in which any intervention used to treat idiopathic intracranial hypertension had been compared to placebo or to another form of treatment in people with a clinical diagnosis of idiopathic intracranial hypertension. DATA COLLECTION AND ANALYSIS: Both authors independently assessed the search results for trials to be included in the review. Discrepancies were resolved by discussion. Since no trials met our inclusion criteria, no assessment of quality or meta-analysis was undertaken. MAIN RESULTS: No randomised controlled trials were found that met the inclusion criteria. AUTHORS' CONCLUSIONS: There is insufficient information to generate an evidence-based management strategy for idiopathic intracranial hypertension. There is inadequate information regarding which treatments are truly beneficial and which are potentially harmful. Properly designed and executed trials are needed.

Bilateral panuveitis: a possible association with Kikuchi-Fujimoto disease.

PURPOSE: To report a case of necrotizing lymphadenitis caused by Kikuchi-Fujimoto disease, which developed bilateral panuveitis. METHODS: A 16-year-old Chinese female with histologically proven Kikuchi-Fujimoto disease developed bilateral panuveitis 2 years after the onset of lymphadenopathy. RESULTS: Bilateral panuveitis was successfully treated with topical steroid. Serologic investigations were positive for Epstein-Barr virus antibodies and antinuclear antibodies, but no evidence of systemic disease or other causes of ocular inflammation was found. CONCLUSION: Kikuchi-Fujimoto disease may be associated with intraocular inflammation.

Comparison of the efficacy of diclofenac and betamethasone following strabismus surgery.

AIMS: To compare the relative antiinflammatory potency and safety of topical diclofenac-gentamicin with betamethasone-neomycin following strabismus surgery. METHODS: A single centre, single observer, prospective, randomised, and double masked clinical trial of 25 children undergoing bilateral symmetrical horizontal strabismus surgery was carried out. One eye received diclofenac-gentamicin and the contralateral eye received betamethasone-neomycin; both treatments were instilled four times a day for 4 weeks postoperatively. Ocular inflammation was assessed at 1 and 4 weeks postoperatively, objectively by comparison with a photographic chart and subjectively by questionnaire. RESULTS: There was no statistically significant difference in the rate of resolution of the inflammatory response between each group at both visits. CONCLUSION: Diclofenac appears to be as effective as betamethasone in controlling postoperative inflammation following strabismus surgery and may offer a safer alternative to the use of topical steroids.

Spontaneous recovery of vision following an orbital haemorrhage.

A 73-year-old man presented to casualty with a penetrating orbital injury and total loss of vision in the affected eye. He subsequently spontaneously recovered full vision. We stress the need for frequent assessment of vision before considering potentially hazardous surgical intervention.

Plasma viscosity or erythrocyte sedimentation rate in the diagnosis of giant cell arteritis?

Plasma viscosity (PV) has replaced the erythrocyte sedimentation rate (ESR) as a routine laboratory test in many hospitals. The finding of a normal PV but raised ESR in a case of biopsy proved giant cell arteritis (GCA) cast doubt on this substitution in cases of suspected GCA. To assess the equivalence of PV and ESR in the diagnosis of this disease 40 suspected cases were prospectively investigated with both tests. The correlation between the two tests was good (r = 0.742, p less than 0.0001). The substitution of one test for the other would appear to be justified in most cases of suspected GCA. In the presence of biopsy proved disease, however, the PV and ESR each produced 13.3% false negatives. These occurred both in combination with and independently of the other test showing that, when in error, the two tests may not be equivalent. In cases of doubt the performing of both PV and ESR tests together improves but does not achieve complete diagnostic accuracy. Clinical judgment based on careful assessment of all available symptoms and signs must remain the foundation of diagnosis.

Papilloedema, a complication of progressive diaphyseal dysplasia: a series of three case reports.

BACKGROUND/AIMS: Progressive diaphyseal dysplasia (PDD) is a rare, autosomal dominant, osteosclerotic dysplasia affecting both endochondrally and intramembranously derived bones. Severely affected patients can develop progressive stenosis of the optic canals and compressive optic neuropathy. Although raised intracranial pressure (ICP) has been described in patients with PDD in whom visual loss has occurred, the elevation of ICP in those patients has been thought to be either non-contributory or only partially responsible for the accompanying visual loss. METHODS: Three cases were reviewed and the clinical and radiological characteristics are described here. RESULTS: All three patients had bilateral optic disc swelling with no radiological evidence of either compressive optic neuropathy or thrombosis of the intracranial venous sinuses. The aetiology of the disc swelling was proved to be papilloedema in the first two cases and was probably the dominant cause in the third case. CONCLUSION: The visual loss documented in at least two of the three patients reported appears to be solely attributable to raised ICP. Normalisation of the ICP has led to an improvement and stabilisation of the visual function in all three patients. Patients with PDD probably require periodic ophthalmic assessments.

Optochiasmal arachnoiditis following muslin wrapping of ruptured anterior communicating artery aneurysms.

Optochiasmal arachnoiditis has been reported following treatment of ruptured intracranial aneurysms, particularly arising from the anterior communicating artery. It has been suggested that the accompanying loss of vision is due to a muslin-induced optic neuropathy. This paper considers five cases of this condition; the response to steroid therapy was beneficial in three cases. A review of the literature is included. The arachnoiditis is considered to be due to an inflammatory response to muslin gauze placed close to the optic nerves and chiasm.

Tailored written invitations for second round breast cancer screening: a randomised controlled trial.

OBJECTIVES: Firstly, to determine if attendance for second round mammography screening in those sent a tailored letter (that is, making reference to their screening history) is increased compared with those sent a standard letter; secondly, to investigate the acceptability of tailored letters. SETTING: North West Glasgow Breast Screening Centre. METHODS: A randomised controlled trial. RESULTS: Overall attendance was unrelated to whether the women were sent a tailored or standard letter; 60% of those sent the standard letter attended (922/1531) compared with 62% of those sent the tailored letter (956/1552) (chi 2 = 0.61, P = 0.4) (difference 2%; 95% confidence interval -2% to 5%). There were no significant differences in percentage attendance within each of the study subgroups: women who attended previously and received an all clear result, women who attended previously and received a false positive result, women who were invited previously and failed to attend, and women who were previously too young to be invited for screening. However, there was a statistically significant difference in percentage attendance between these four groups, independent of letter type (chi 2 = 510, P < 0.00001). Although women found the letters acceptable and understandable, they did not seem to pay close attention to the content. CONCLUSIONS: Tailoring invitation letters does not have a significant effect on uptake rates for breast screening and does not justify the additional workload required.

Interventions for idiopathic intracranial hypertension.

BACKGROUND: Idiopathic intracranial hypertension (IIH) occurs throughout the world with an estimated incidence of one to three per 100,000 population per year. It occurs most commonly in obese young women, but the cause is unknown. It presents a significant threat to sight and is associated with severe morbidity in the form of headaches in the majority of cases. Several different treatments have been proposed, ranging from relatively conservative measures such as diuretic therapy to more invasive treatments such as optic nerve sheath fenestration or lumbo-peritoneal shunting. OBJECTIVES: The aim of this review is to assess the evidence from controlled trials looking at the various treatments used for idiopathic intracranial hypertension with a view to producing an evidence-based treatment strategy. SEARCH STRATEGY: We searched the Cochrane Controlled Trials Register - CENTRAL/CCTR (which contains the Cochrane Eyes and Vision Group specialised register) on the Cochrane Library Issue 2, 2002, MEDLINE (1966 to March 2002) and EMBASE (1980 to February 2002). SELECTION CRITERIA: We included only randomised controlled trials in which any intervention used to treat idiopathic intracranial hypertension had been compared to placebo or to another form of treatment in people with a clinical diagnosis of idiopathic intracranial hypertension. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed the search results for trials to be included in the review. Discrepancies were resolved by discussion. Since no trials met our inclusion criteria, no assessment of quality or meta-analysis was undertaken. MAIN RESULTS: No randomised controlled trials were found that met the inclusion criteria. REVIEWER'S CONCLUSIONS: There is insufficient information to generate an evidence-based management strategy for idiopathic intracranial hypertension. Of the various treatments available, there is inadequate information regarding which are truly beneficial and which are potentially harmful. Properly designed and executed trials are needed.

An evaluation of community antenatal care.

A study to ascertain how the community based antenatal services in the East End of Glasgow related to the guidelines set by a Working Party on Ante-Natal and Intrapartum Care (Royal College of Obstetricians and Gynaecologists, 1982) is reported. All community based clinics were visited and described. The socio-economic status of the sample population was defined and users' views and preferences sought. The women sampled were often socially and economically disadvantaged. Unemployment was high. They received their community antenatal care from midwives, general practitioners and consultants in both health centres and general practitioner surgeries. Women were generally satisfied with the care they received. Answers to more specific questions indicated, however, that more information and individualised care would be appreciated.

Should obstetricians see women with normal pregnancies? A multicentre randomised controlled trial of routine antenatal care by general practitioners and midwives compared with shared care led by obstetricians.

OBJECTIVE: To compare routine antenatal care provided by general practitioners and midwives with obstetrician led shared care. DESIGN: Multicentre randomised controlled trial. SETTING: 51 general practices linked to nine Scottish maternity hospitals. SUBJECTS: 1765 women at low risk of antenatal complications. INTERVENTION: Routine antenatal care by general practitioners and midwives according to a care plan and protocols for managing complications. MAIN OUTCOME MEASURES: Comparisons of health service use, indicators of quality of care, and women's satisfaction. RESULTS: Continuity of care was improved for the general practitioner and midwife group as the number of carers was less (median 5 carers v 7 for shared care group, P<0.0001) and the number of routine visits reduced (10.9 v 11.7, P<0.0001). Fewer women in the general practitioner and midwife group had antenatal admissions (27% (222/834) v 32% (266/840), P<0.05), non-attendances (7% (57) v 11% (89), P<0.01) and daycare (12% (102) v 7% (139), P<0.05) but more were referred (49% (406) v 36% (305), P<0.0001). Rates of antenatal diagnoses did not differ except that fewer women in the general practitioner and midwife group had hypertensive disorders (pregnancy induced hypertension, 5% (37) v 8% (70), P<0.01) and fewer had labour induced (18% (149) v 24% (201), P<0.01). Few failures to comply with the care protocol occurred, but more Rhesus negative women in the general practitioner and midwife group did not have an appropriate antibody check (2.5% (20) v 0.4% (3), P<0.0001). Both groups expressed high satisfaction with care (68% (453/663) v 65% (430/656), P=0.5) and acceptability of allocated style of care (93% (618) v 94% (624), P=0.6). Access to hospital support before labour was similar (45% (302) v 48% (312) visited labour rooms before giving birth, P=0.6). CONCLUSION: Routine specialist visits for women initially at low risk of pregnancy complications offer little or no clinical or consumer benefit.

The health status and health needs of Chinese population in Glasgow.

This cross sectional study explored the health problems and health needs in the local Chinese community in Glasgow. Several data collection methods have been used in this study, including face-to-face and telephone structured interviews, postal and hand delivered questionnaires. A total of 800 questionnaires were processed, and 493 were completed, giving an overall response rate 61.6%. The results from the present survey indicated that the health status of Chinese residents in Glasgow is poorer than that of the local population. The most important findings of the study is that the Chinese community in Glasgow underuse health services, and unmet health needs exist in the community. The main barrier to effective use of present health services and benefit from the health promotion and health education programmes is language difficulties. Following discussion with the local community, options for improving the health services for the Chinese community in Glasgow were obtained. The findings of the study have implications for health service purchaser/providers of health care to the Chinese population generally in Scotland.

Contact lens related problems presenting in casualty.

The use of contact lenses in preference to spectacles has gained much popularity over recent years. This, however, is not without its complications and eye departments are now seeing an increasing number of contact lens related eye disease. This study seeks to show the range of complications seen, their treatment and outcome. It also outlines the types of contact lens in popular use, the reason for wear, the duration of wear and the sex, age and professional distribution of contact lens wearers.

AIDS-related attitudes and knowledge among attenders at a Scottish family planning clinic.

AIDS-related attitudes and knowledge of 1,970 family planning clinic attenders were examined using a self-completion questionnaire. Attitudes towards testing varied depending on the sex, age and marital status of respondents. Knowledge of HIV transmission routes was generally good, although the fact that those most likely to be at risk of infection--the younger respondents and those not currently in steady relationships--were the least well-informed gives some cause for concern. Since family planning consultations are frequently the only contact these young sexually active individuals have with the health service the opportunities for health education on HIV/AIDS afforded by regular attendance at these clinics should be capitalized upon.

PIP: In Glasgow, Scotland, 1970 people responded to a survey about AIDS knowledge, attitudes, and practices at the main family planning clinic. Most favored AIDS services in family planning clinics. Responses concerning what groups should be tested for HIV varied(36% everyone; 56w all pregnant women; and 63% all homosexual men). Moreover, 77% felt intravenous drug users should be tested, yet this group do not represent the largest group of AIDS/HIV cases. Indeed respondents had a tendency to believe that testing programs should be directed at others and not themselves. Those 20 and those 30 tended to say everyone should be tested (p.0001). 25-29 respondents exhibited the least zeal for testing of all pregnant women (p.001), yet 51% felt pregnant women should be tested. 73% of men and 62% of women favored routine testing of homosexual men which may reflect homophobia (p.001). Married people and those in steady relationships also favored testing homosexual men (p.005). Only 26% of respondents believed they knew enough about AIDS whereas 54% believed they did not know enough. Those 20 and those not in a steady relationship were least likely to feel they were well informed (p.001 and p.005 respectively). Respondents basically knew how HIV is transmitted, but 16% thought that donating blood would transmit HIV and another 16% were not sure if it did or not. In fact, those 20 were most likely to believe they could get HIV through donating blood (p.0001). Only 83% knew that safe sex reduces risk. Those not in a steady relationship were least likely to know about safe sex (p.005) and that a mother can infect an unborn baby with HIV (p.05). Those 20 felt only homosexual men were at risk (p.05) and that one could tell if someone is HIV infected by looking at him/her (p.01). They also tended not to know about the risk of receiving blood transfusions in the past (p.0001).

The neonatal consequences and neonatal cost of reducing the number of embryos transferred following IVF.

This clinical audit project examined the effects of change of policy between 1990 and 1993 transferring an average two (maximum three for particular cases) embryos to women undergoing IVF in the West of Scotland programme. All women who achieved clinical pregnancy in 1990 (92 women) and 1993 (93 women) as a result of the IVF programme were included in the study. The hospital records of women via the programme were analysed. The results of the study showed that there was a significant reduction in the rate of multiple pregnancy, preterm birth and low birth weight babies in the 1993 group (new policy). The cost of neonatal intensive care in 1993 for babies born following IVF was about nine times lower than that in 1990 (old policy). This study concluded that a policy of transferring two embryos (or three for particular cases) to women in an IVF programme, had improved the perinatal outcome and reduced the cost of the neonatal service for those babies.