Stab wounds to the back and flank in the hemodynamically stable patient: a decision algorithm based on contrast-enhanced computed tomography with colonic opacification.

PURPOSE: The authors wanted to determine whether contrast-enhanced computed tomography (CE-CT) with colonic opacification is an accurate tool to triage hemodynamically stable victims of stab wounds to the flank and back. PATIENTS AND METHODS: One hundred forty-five consecutive patients were categorized as low-risk ( penetration superficial to the deep fascia) or high-risk (penetration beyond the deep fascia) based on CE-CT findings. RESULTS: There were no significant differences in admission vital signs, Glasgow Coma Scale, or complete blood counts between low- and high-risk groups. None of the 92 low-risk patients required surgery or had sequelae. Six of the 53 high-risk patients underwent surgery, 2 based on initial CE-CT, 4 due to evolving clinical signs. The CE-CT correctly predicted surgical findings in all cases. CONCLUSIONS: Hemodynamically stable patients with stab wounds to the back and/or flank can be successfully triaged based on CE-CT findings. Low-risk patients may be discharged immediately. High-risk patients may have a discharge decision implemented at 24 hours.

Complications from anterior chamber lenses: report of cases.

This is a report of cases of complications from anterior intraocular lenses. Problems discussed include dislocated, misfit, or malpositioned implants and methods of surgical correction. The importance of accurate anterior chamber diameter measurement, flexible anterior chamber lenses, and stability of lens fixation for successful anterior chamber surgery is stressed.

Vitreous changes after neodymium-YAG laser irradiation of the posterior lens capsule or mid-vitreous.

Exposure of four monkey and 26 rabbit eyes to neodymium-YAG laser irradiation to the posterior lens capsule or the mid-vitreous area clearly demonstrated significant vitreous changes (liquefaction) as measured by viscosity analyses and proton relaxation studies. We found marked molecular alterations in the vitreous of the exposed eye compared with the contralateral control (unirradiated) eye. These alterations, occurring immediately after laser treatment, were probably the result of acoustic transients accompanying the laser irradiation.

Control of astigmatism by wound placement.

We performed a clinical surgical study of extracapsular extraction/phacoemulsification and lens implantation to determine the effectiveness of posterior wound placement in reducing immediate astigmatism. One hundred three cases, one half with anterior wounds and one half with posterior wounds, were analyzed for cylinder, axis, and astigmatism at six days and six weeks. We found little change in the amount of preexistent astigmatism with posteriorly placed wounds. The change was much greater with anteriorly placed wounds.

Results of monovision correction in bilateral pseudophakes.

We performed a retrospective study of the postoperative use of glasses in 100 patients with bilateral posterior chamber implants. Patients' vision had been corrected with one emmetropic eye and one myopic eye for simultaneous distance and near vision without glasses. The number of patients wearing bifocals preoperatively declined by half with this technique. Postoperatively, 11% of patients wore glasses out of habit, even though their visual acuities were equivalent to those of the 14% who subjectively needed no correction after surgery. The results of the study and the advantages of this monovision method of optical correction in bilateral pseudophakes are discussed.

Examination of YAG laser marks on intraocular lenses.

A lathe-cut intraocular lens was hit with the mode-locked YAG laser. The resulting marks (dinks) were examined with scanning electron microscopy and are described.