Effects of scleral buckling on the retrobulbar haemodynamic changes

PURPOSE

This study was planned to investigate blood flow changes due to scleral buckling surgery. In addition the effects on these changes of factors related to patient characteristics and operative technique were studied.

METHODS

Central retinal artery (CRA) and ophthalmic artery (OA) blood flow velocities were studied with colour Doppler ultrasonography after scleral buckling surgery in 25 patients with unilateral rhegmatogenous retinal detachment. The effects of the patient's age, referral time, aetiological factors, operative technique, cryotherapy width and buckling distance on the haemodynamic changes were noted.

RESULTS

Buckling surgery reduces the blood flow velocities in the CRA, but affects OA blood flow less. Encircling is found to be responsible and it is greater in patients with anatomical success. Other factors do not have any significant effect on these changes.

CONCLUSIONS

Good anatomical and functional results can be achieved despite these haemodynamic changes. It must be kept in mind that these changes may cause complications in some patients and the surgery must be minimized.

Milk of calcium fluid collections in juvenile dermatomyositis: MR characteristics

Children with dermatomyositis may have extensive subcutaneous and intermuscular calcium-laden fluid collections referred to as "milk of calcium." The distinctive MR appearance of such collections in an upper extremity of a 16-year-old girl is presented. MR can differentiate these collections from abscesses and guide appropriate therapy.

Spontaneous right ventricular rupture after sternal dehiscence: a preventable complication?

Mediastinitis and/or sternal dehiscence developed in 143 out of 10,263 patients (1.4%) who underwent cardiac surgery between January 1979-December 1993. Mediastinal drainage, sternal debridement and early wound closure with pectoralis major and/or rectus abdominalis muscle flaps was the treatment employed. Between these two stages of treatment, massive hemorrhage developed in seven patients (0.07%) from a tear of the anterior wall of the right ventricle (RV). Six patients survived. Temporary control of the bleeding was achieved with digital or full palm pressure control of the ventricular tear. This was followed by immediate repair in the operating room (OR). The only death was due to exsanguination in the intensive care unit. The other six patients were taken to the OR. The anterior RV was freed from the underside of the sternum and the RV tear repaired with or without the aid of femoral-femoral bypass. These six then had muscle flap wound closures at that time or shortly after. All six were hospital survivors and are currently alive. We believe that RV rupture results from the sternal edges pulling the anterior surface of the RV apart, since the RV is stuck to the underside of the sternum. This experience indicates that the RV must be freed in all cases during initial sternal debridement. Hopefully this simple maneuver will prevent this horrendous complication.

A unique case of high-pressure injection injury of the hand

A unique case of high-pressure injury to the hand is described with extension of the injectate to the elbow. Diagnosis includes the need for high levels of suspicion and evaluation by radiography. Meticulous debridement and copious saline lavage, and decompression of the carpal tunnel space, followed by split-thickness grafting, were successful in this case.

Early management of burned patients

Evaluation of the burned patient in the emergency department and fluid resuscitation of burned patients are discussed in detail.

Microwave radiation injury

A case of momentary exposure of the right hand to irradiation from a microwave oven is described. Transient paresthesias and a cold, pale hand resulted but resolved spontaneously in 60 minutes without treatment. Even momentary exposure can result in severe coagulation necrosis, with eventual loss of the exposed extremity.

Hyperosmolality caused by percutaneously absorbed glycerin in a burned patient

Hyperosmolality complicating the management of burned patients has multiple etiologies. Sepsis, hyperglycemia, renal failure, electrolyte disturbances, shock, and substances absorbed from the burn wound may be contributing factors. Chemicals, such as propylene glycol, within bacteriostatic topicals may also lead to hyperosmolality. This report describes a patient who developed severe hyperosmolality after 5% Betadine-glycerin therapy for a 60% partial-thickness burn. Status epilepticus developed 36 hours later, and triglycerides were 9,700 mg/dl. After Betadine-glycerin was stopped the central nervous system status slowly improved but pre-seizure function was never regained.

Treatment of burns by exposure in an attempt to reduce cross infection

The advantages of treatment with betadine and glycerol are: cost containment of agent and dressings, ease of observing wounds, reduction of direct nursing care and, most importantly, reduction of ward epidemics, especially Pseudomonas. Major disadvantages are increased time to grafting, potential psychological effects on patients and visitors upon viewing the wounds and the relatively minor pain during application.

Gasoline contact burns

In the past four years, four cases of gasoline contact burns have been treated at the Detroit General Hospital Emergency Department. Signs are erythema and blister formation within 24 hours. Treatment is removal of contaminated clothing and washing the surface with soap and water plus open exposure of the wounds. Renal failure is not caused by skin absorption but may develop following inhalation.

Drug injection injuries of the hands: evaluation and treatment

Twenty-six patients with hand infections caused by drug injection were seen at Detroit General Hospital between 1974 and 1976 and were followed up. The duration of drug abuse was 2 to 25 years. The time before the patient sought medical help ranged from three days to 20 weeks. Among the 26 patients were three webspace infections, three finger abscesses, four gangrene of distal phalanx, nine cellulitis and abscess, one ulceration of the thenar eminence, and two ulcerations of the volar aspect. Follow-up was difficult due to unreliability of drug addicts.