Hyperbaric oxygen therapy for perioperative posterior ischemic optic neuropathy: a case report

PURPOSE

To report the successful treatment of postoperative posterior ischemic optic neuropathy (PION) with hyperbaric oxygen therapy and to review the current literature on the pathogenesis and treatment of PION.

OBSERVATIONS

During an angiographic procedure at a community hospital, an elderly woman had a transient drop in blood pressure after receiving an intravenous dose of hydralazine. During recovery, the patient experienced bilateral vision loss. She was transferred to our specialty referral center for treatment with hyperbaric oxygen. We followed Table 5 in the U.S. Navy Diving Manual, the protocol for decompression sickness. Our patient's vision improved markedly immediately after the first session and continued to improve throughout the course of treatment to its completion. Follow-up ophthalmology visits found the patient's vision to be close to baseline.

CONCLUSIONS AND IMPORTANCE

PION is a rare condition. It has been difficult to determine a successful therapeutic approach because of the lack of large case-controlled studies. Hyperbaric oxygen has been used to treat other ischemic ophthalmic conditions, but there are only few reports of its use in patients with PION. Systemic steroids and antiplatelet therapy have also been used, with mixed success. In our patient, the combination of hyperbaric oxygen therapy and steroids was successful in restoring vision after postoperative PION.

Impact of water troughs on cattle use of riparian zones in the Georgia Piedmont in the United States

Cattle use of riparian areas may lead to stream water contamination with nutrients, pathogens, and sediments. Providing alternative water away from the stream may reduce the amount of time cattle spend near streams and therefore reduce contamination. We conducted this study to 1) evaluate the effect of providing water troughs outside of the riparian zones on the amount of time cattle spend in riparian zones, and 2) evaluate if environmental factors such as temperature and humidity affect the impact of water trough availability on the amount of time cattle spend within riparian and nonriparian locations. Global positioning system (GPS) collars were used to document cow locations every 5 min in 2 mixed tall fescue/common bermuda-grass pastures of the Georgia Piedmont in the United States. We found that when the temperature and humidity index (THI) ranged between 62 and 72, providing cattle with water troughs outside of riparian zones tended to decrease time cattle spent in riparian zones by 63% (52 min x d(-1); P = 0.11). When THI ranged between 72 and 84, nonriparian water availability did not have a significant impact on the amount of time cattle spent in the riparian zone or in riparian shade. These results suggest that water troughs placed away from unfenced streams may improve water quality by reducing the amount of time cattle spend in riparian zones when environmental conditions as evaluated by THI are not stressful.

Maternal understanding of diarrhoea-related dehydration and its influence on ORS use in Indonesia

Dehydration resulting from diarrhoea remains a significant cause of death for young children in developing countries such as Indonesia. Although Oral Rehydration Solution (ORS) is effective in preventing and treating dehydration, its use in home treatment is not widespread. This study sought to assess whether mothers' understanding of diarrhoea-related dehydration influenced their use of ORS in home treatment. One hundred mothers of children under the age of five years in rural Indonesia were surveyed using a structured questionnaire, administered in an interview format in their homes. Only 38 (38%) of the mothers surveyed could identify two or more correct signs of dehydration. Significant relationship was found between maternal knowledge of correct signs of dehydration and the use of ORS in home treatment (OR 3.36, 95% CI 1.24, 10.63). Resulting recommendations include improved health education programming for mothers of young children, as well as future programme evaluation and intervention studies.

Phosphorus, sediment, and Escherichia coli loads in unfenced streams of the Georgia Piedmont, USA

Contamination of unfenced streams with P, sediments, and pathogenic bacteria from cattle (Bos taurus) activity may be affected by the availability of shade and alternative water sources. The objectives of this study were to evaluate water quality in two streams draining tall fescue (Festuca arundinacea Schreb.)-common bermudagrass (Cynodon dactylon L.) pastures with different shade distribution, and to quantify the effects of alternative water sources on stream water quality. For 3 yr, loads of dissolved reactive phosphorus (DRP), total phosphorus (TP), and total suspended solids (TSS) were measured during storm flow, and loads of DRP, TP, TSS, and Escherichia coli were measured every 14 d during base flow. We also used GPS collars to determine amount of time cattle spent in riparian areas. Our results showed that cattle-grazed pastures with unfenced streams contributed significant loads of DRP, TP, TSS, and E. coli to surface waters (p < 0.01). Time spent by cattle in riparian areas as well as storm flow loads of DRP, TP, and TSS were larger (p < 0.08) in the pasture with the smaller amount of nonriparian shade. Water trough availability decreased base flow loads of TSS and E. coli in both streams, and decreased time cattle spent in riparian areas in the pasture with the smaller amount of nonriparian shade (p < 0.08). Our results indicate that possible BMPs to reduce contamination from cattle-grazed pastures would be to develop or encourage nonriparian shade and to provide cattle with alternative water sources away from the stream.

Neurobehaviour rounds and interdisciplinary education in neurology and psychiatry (698)

Increasing emphasis on interdisciplinary medical treatment and education suggests that something valuable has arisen from medical specialization beyond the further development of specialty knowledge: an integration of specialty knowledge that compliments and extends the integrating aspects of the primary care approach to medicine. Several educational models have been described which serve this function. In this paper the authors describe interdisciplinary clinical teaching, and research team linking neurology, neuroradiology, psychiatry and neuropsychology. The team provides neurobehavioural evaluations and sponsors monthly Neurobehaviour Rounds, an interdisciplinary patient conference that is the main formal teaching vehicle for the programme. After the model had been in place for 1 year, eight of nine neurology residents had Residency In-Service Training Examination scores in behavioural neurology that exceeded their overall average scores. This suggests that encouraging neurology residents to see patients through the eyes of different specialists may have contributed to improvement in their performance on a test of interdisciplinary knowledge. A neurobehavioural programme anchored to a formal neurobehaviour conference may encourage interdisciplinary learning within the related disciplines of neurology, neuropsychology and psychiatry.

Assessments and suggested interventions to assist newborn breastfeeding behavior

Assessment of the newborn infant in the first few days after birth is important to ensure that the newborn and mother are beginning to establish lactation successfully. This article discusses breastfeeding assessment of the healthy neonate and includes a description of the Infant Breastfeeding Assessment Tool (IBFAT), a checklist on which neonatal breastfeeding behavior can be scored. Some interventions are suggested for those babies who may be having difficulties.

Neurobehavior rounds. Their role in promoting psychiatric liaison in a neurology inpatient unit

A joint neurobehavior conference was established utilizing the models of Lipowski's Montreal conference and Geschwind's aphasia and neurobehavior rounds at the Boston VA Hospital in 1991. The authors report on the usefulness of this conference in promoting the goals of psychiatric consultation and liaison on a neurology inpatient unit, specifically on patient care, education, and collegiality. The value of the multidisciplinary approach in solving complex neuropsychiatric problems is also discussed.

Experiences of primiparous breast-feeding mothers in the first days following birth

This study describes the breast-feeding patterns of 59 neonates and the experiences of their primiparous mothers during the early postpartum period. The results showed that most mothers and babies in this group had significant difficulties during the first 2 days after birth and that 33% of the mother-baby pairs were still having problems latching or sucking on discharge from hospital (fourth to fifth postpartum days). Of the mothers who were still having problems on leaving the hospital, 84% had given up breast-feeding by 8 weeks, most of them by 2 weeks following hospital discharge.

Unmarried motherhood

In the past, the children of unmarried women were stigmatized and treated as second-class citizens by both society and the law. As societal attitudes have become more tolerant, however, the laws have been changed to ensure equality for all children. Despite this, there is little evidence to show that the children of unmarried mothers receive the rights guaranteed them by law, or that the birth parents and caregivers are even aware of those rights.

Persistent extrapyramidal syndrome with dystonia and rigidity caused by combined metoclopramide and prochlorperazine therapy

We have reported the case of a 58-year-old woman with cerebral palsy who experienced a persistent, generalized syndrome of dystonia and rigidity (tardive dystonia-parkinsonism) while being treated for vomiting with metoclopramide in combination with prochlorperazine. This syndrome was more severe than is typically seen in drug-induced extrapyramidal syndromes and may have contributed to her death. The extreme severity of this disorder was probably related to the use of a combination of dopamine antagonists in a patient who had premorbid cerebral dysfunction. Although dopamine antagonists should always be used with caution in individuals with cerebral dysfunction, this particular combination of antiemetics should probably be avoided in such patients.

Mothers' satisfaction with their neonates' breastfeeding behaviors

This study examined the relationship between breastfeeding competence in neonates and maternal satisfaction with breastfeeding during the early postpartum period. Mothers assessed their neonates' feeding behaviors and checked the satisfaction item on the study instrument at every feeding. Feeding scores and maternal scores were analyzed. The higher the neonate scored (i.e., the more effective the feeding), the more pleased the mother was with the feeding. Neonates of primiparous mothers had lower mean scores than neonates of multiparous mothers, and primiparous mothers were displeased with a higher percentage of feedings compared with the multiparous mothers (p less than .05).

The relationship between maternal labour analgesia and delay in the initiation of breastfeeding in healthy neonates in the early neonatal period

An Infant Breastfeeding Assessment Tool was used to assess the breastfeeding behaviour of 38 healthy, full-term newborn babies of multiparous women from birth until effective feeding was established. After data collection was completed, the babies were divided into a non-medicated group (n = 18) and an alphaprodine group (n = 20) based upon the medication profile of the mother. Inter-group differences were analysed using ANOVA and Dunnett's t-test. The dependent variables were the hours from birth to establishing effective breastfeeding and IBFAT scores at 12, 24, 36 and 48 hours after birth. The findings suggest that even small doses of the narcotic analgesic alphaprodine, when administered 1 to 3 hours prior to delivery, can delay effective feeding by several hours and in some cases, days.

Four- versus five-day estrous cycles in rats: vaginal cycling and pregnancy

Five- compared to four-day cycling rats had earlier onsets and prolonged periods of full vaginal cornification at estrus, and similar times of the first appearance of the "pavement" cells that signal the end of estrus. In mating tests, a larger proportion of five- compared to four-day cyclers became either pregnant or progestational after mating to one ejaculation by the male. As groups, four- and five-day cyclers did not differ in measures of male or female sexual behavior during the mating test. The observed differences between four- and five-day cyclers in the progestational response to one ejaculatory series and in cyclic vaginal cytology are consistent with previously reported hormonal differences between four- and five-day cycling female rats.