Hyperbaric oxygen treatment for paracentral acute middle maculopathy: a case study

A 47-year-old active-duty Navy diver with a complicated past medical history which resulted in his designation as not physically qualified (NPQ) for diving duty in 2016 presented on 07 May 2021 complaining of left-sided blurred vision. On exam by the attending undersea medical officer, he was found to have a left upper inner and upper outer quadrant visual field defect and a central scotoma. Urgent referral to ophthalmology ruled out retinal detachment but resulted in an initial diagnosis of a left branch retinal artery occlusion without embolus. Considering this a variant of central retinal artery occlusion, hyperbaric oxygen (HBO2) therapy was initiated approximately 12 hours after symptom onset, resulting in complete, though temporary, resolution of the visual field defect. He reported that after completion of his first HBO2 treatment, his visual field deficit began to return, but the deficit again resolved after initiating surface oxygen therapy between HBO2 treatments. After two days of continuous surface oxygen and daily HBO2 treatments, which minimized his visual field defect, his deficits changed to a persistent left lateral peripheral defect and a recurrent central nasal defect. At this time, his periodic ophthalmology evaluation revised his diagnosis to cilioretinal artery occlusion (CrAO). Further evaluation by ophthalmology revealed retinal changes consistent with a secondary diagnosis of paracentral acute middle maculopathy (PAMM), an ophthalmologic condition only recently defined in the literature (2013) [10] secondary to advances in retinal imaging technology. This case is presented to share the findings of this complicated case and to postulate a benefit from using HBO2 for cilioretinal artery occlusion with PAMM.

THE ORIGIN OF PLATELETS : THEIR BEHAVIOR IN THE HEART-LUNG PREPARATION

1. In heart-lung preparations perfused with heparinized blood, clumping of platelets and a sharp fall in the platelet count occurred in the first 5 to 15 minutes after the external circuit was established. 2. In 10 such preparations surviving from 1 to 4 hours, only one showed a return of the platelet count to the level existing before operation. 3. When platelets were reduced in numbers before the blood was used for perfusion, the count tended to level off after a small recovery, if any. 4. An estimate of clumping showed it to bear an inverse relationship to the platelet recovery. 5. No satisfactory evidence of platelet production in the lungs has been obtained in these studies with heart-lung preparations. 6. The possibility of special factors which may influence platelet formation is discussed.

Pierre Robin sequence and double aortic arch: a case report

We present an 8-day-old female with two admissions for respiratory failure. On the first admission, the diagnosis of Pierre Robin sequence (PRS) and laryngomalacia was made after assessment with chest radiography, echocardiography, and flexible fiberoptic laryngoscopy. Four days after discharge, the child presented with stridor and respiratory distress, and a new cardiac murmur was noted after admission. Repeat echocardiography, with confirmatory direct laryngobronchoscopy, revealed a double aortic arch (DAA) with distal tracheal compression. This case illustrates the necessity of a complete otolaryngic evaluation, including direct laryngobronchoscopy, to search for a synchronous airway lesion in any neonate with severe respiratory distress associated with stridor.

Isinglass as a Transfusion Fluid in Haemorrhage

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