The incidence of ocular candidiasis and evaluation of routine opthalmic examination in critically ill patients with candidaemia.

Despite a paucity of data regarding both the incidence of ocular candidiasis and the utility of ophthalmic examination in critically ill patients, routine ophthalmic examination is recommended for critically ill patients with candidaemia. The objectives were to estimate the incidence of ocular candidiasis and evaluate whether ophthalmic examination influenced subsequent management of these patients. We conducted a ten-year retrospective observational study. Data were extracted for all ICU patients who were blood culture positive for fungal infection. Risk factors for candidaemia and eye involvement were quantified and details regarding ophthalmic examination were reviewed. Candida species were cultured in 93 patients. Risk factors for ocular candidiasis were present in 57% of patients. Forty-one percent of patients died prior to ophthalmology examination and 2% of patients were discharged before candidaemia was identified. During examination, signs of ocular candidiasis were only present in one (2.9%) patient, who had a risk factor for ocular candidiasis. Based on these findings, the duration of antifungal treatment for this patient was increased. Ocular candidiasis occurs rarely in critically ill patients with candidaemia, but because treatment regimens may be altered when diagnosed, routine ophthalmic examination is still indicated.

Accidental transplantation of bronchial carcinoma from a cadaver donor to two recipients of renal allografts.

Malignancy was transferred inadvertently to two patients, each of whom received a renal transplant from a cadaver donor who was found at necropsy to have a small, clinically silent carcinoma of lung. Both recipients died with metastatic bronchial carcinoma of the same histological type as the donor's tumour. The literature on transplanted malignancy is reviewed.

Photoastigmatic refractive keratectomy for compound myopic astigmatism with a Nidek laser.

BACKGROUND: With advances in the delivery of excimer laser energy to the cornea, spherocylindrical ablations are now possible. The refractive and visual outcome of eyes undergoing photoastigmatic refractive keratectomy with a minimum of 12 months follow-up are presented. METHODS: A retrospective analysis of 160 consecutive eyes that underwent photoastigmatic refractive keratectomy using the Nidek EC5000 excimer laser was undertaken. One year follow-up data were available on 89 eyes. Vector analysis of the change in cylindrical error, by the Alpins method, was performed. Before surgery, the mean spherical equivalent refraction was -5.68 diopters (D) (SD 2.67 D) with a mean cylinder power of -1.40 D (SD 0.75). RESULTS: At 1 year after surgery, the mean spherical equivalent was -0.44 D (SD 0.87). Seventy-one eyes (79.8%) had a spherical equivalent within 1.00 D of the target refraction and 79 eyes (89%) achieved 6/12 or better, unaided. Four of 89 eyes (4.5%) lost more than two lines of spectacle-corrected visual acuity with 9 eyes (10%) gaining Snellen acuity, comparing preoperative spectacle-corrected acuity with postoperative uncorrected visual acuity. The mean coefficient of adjustment (targeted induced astigmatism vector magnitude divided by surgically induced astigmatism vector magnitude) was 1.11 (SD 1.33), indicating undercorrection of the cylinder. The mean angle of error was 0.73 degree (+/- 10.91). CONCLUSIONS: Refractive visual acuity outcome after photoastigmatic refractive keratectomy was good. Current algorithms undercorrect the cylinder power, but are adequately aligned. Algorithms for toric ablations in the Nidek EC5000 need to be improved.

A co-operative study on the clinical value of dynamic renal scanning with deconvolution analysis.

An international project was set up to study the clinical usefulness of intrarenal transit times derived from the renogram by deconvolution. A common data sheet, to collect clinical, biochemical, radiological and isotopic information, was completed by the centres. Five hundred and ninety-one patients were studied and the results analysed. The mean transit time (MTT) in normal kidneys was found to be 3.6 +/- 1.1 min. If the MTT is greater than 7.6 min, a kidney is likely to be obstructed. In vesico-ureteric reflux, the transit times are prolonged, but they are normal in infection, hypertension, parenchymal disease and minimally irradiated kidneys. In transplantation, when the kidney is normal, the transit times are shorter than in the natural kidney; in acute rejection, transit time are prolonged.

Survival of bacteria on the ocular surface following double application of povidone-iodine before cataract surgery.

AIMS: This study assessed the effectiveness of one vs two applications of povidone-iodine in decontaminating the eye before cataract surgery. METHODS: This was a prospective, interventional study of 52 patients having elective unilateral phacoemulsification cataract surgery in a tertiary care centre. Each patient had two applications of povidone-iodine before phacoemulsification cataract surgery, separated by 10 min. Conjunctival swabs were taken before and after each application and cultured in 5% CO(2) and anaerobically. Statistical analysis was performed using McNemar's test for correlated proportions. RESULTS: In all, 15 of 52 (29%) patients had positive cultures before the first application and 21 of 52 (40%) patients had positive cultures after it. This was not statistically significant (P=0.239). A total of 25 of 52 (48%) patients were culture positive before the second application. This was not statistically significantly different from 10 min earlier (P=0.423). Six of 52 (12%) patients were positive after the second application (P<0.001). CONCLUSIONS: We conclude that the initial application of povidone-iodine was not effective in decontaminating the eye. Recontamination did not take place between applications. The difference in the proportion of patients with positive results before and after the second application of povidone-iodine was statistically significant. We infer from this that double application of povidone-iodine before cataract surgery is advisable.

The use of a small programmable calculator in intravenous feeding.

This paper describes a method using a programmable calculator to determine intravenous nutritional requirements of severely ill patients. A description of the method and calculations used is given. The advantages of this system are shown to lie in its easy availability to all hospital departments.

Gas exchange in renal failure. I. Dangers of hyperkalaemia during anaesthesia.

Failure to maintain compensatory hyperventilation during anaesthesia in patients with metabolic acidosis results in an increase in PaCO(2), fall in blood pH, and a possible rise in plasma potassium. This sequence of events may account for unexplained operative deaths in patients in renal failure.

Gas exchange in renal failure. II. Pulmonary gas exchange during peritoneal dialysis.

Blood gas analysis studies have been made in patients undergoing peritoneal dialysis. It has been shown that oxygen tensions are reduced when fluid has been run into the peritoneal cavity and that this fall in Pao(2) is reversed after running out the dialysate. The change in Pao(2) is greater with 2-litre than with 1-litre cycles.

Deceleration trauma to the heart and great vessels after road-traffic accidents.

Four young men involved in high-speed car crashes developed cardiovascular trauma. Two patients had aortic aneurysms, one rupture of the mitral valve, and one ventricular septal defect; successful surgical correction was undertaken in all. The importance of considering the possibility of cardiovascular trauma in these circumstances is emphasized, and x-ray films (repeated if necessary) should be taken even when there are no external signs of trauma.

Characterization of antibodies as probes for structural and biochemical studies of tektins from ciliary and flagellar microtubules.

Rabbit antibodies raised and purified against three tektins, proteins of flagellar doublet microtubules from sea-urchin sperm (Lytechinus pictus and Strongylocentrotus purpuratus), were used to study tektin biochemistry and their structural localization. Doublet microtubules were fractionated into tektin filaments and separated by SDS-PAGE into three major tektin polypeptide bands (Mr = 47, 51 and 55 (X 10(3)), which were used to immunize rabbits. Antibodies against each tektin (anti-tektins) were affinity-purified and then characterized by two-dimensional isoelectric focusing/SDS-PAGE immunoblotting and by immunofluorescence microscopy. In two-dimensional immunoblots of 0.5% Sarkosyl-resistant fractions of flagellar microtubules, the antibody against the 55 X 10(3) Mr tektin (anti-55) stained one major polypeptide of 55 X 10(3) Mr and pI 6.9, anti-51 stained two polypeptides of 51 X 10(3) Mr and pI approximately 6.15, and anti-47 stained one major polypeptide of 47 X 10(3) Mr and pI 6.15. The anti-tektins also stained several minor neighbouring polypeptides, which may be isoelectric variants, novel tektins or unrelated proteins. Furthermore, anti-47 crossreacted with the major 55 X 10(3) Mr polypeptide. By immunofluorescence microscopy all three anti-tektins stained methanol-fixed echinoderm sperm flagella and embryonic cilia. In addition, anti-47 and anti-55 stained unfixed, demembranated axonemes. Besides staining axonemes, all anti-tektins labelled the basal body region, and anti-51 labelled the sperm head envelope. These results indicate that the tektins are a complex family of proteins that are components of axonemal microtubules and possibly other cytoplasmic and nuclear structures.