This study comprises 228 patients with penetrating injuries of the subclavian vessels. The vein alone was involved in 44 per cent, the artery alone in 39 per cent, and both vessels in 17 per cent. The majority of the victims (61 per cent) did not reach the hospital alive, and in those who were operated on the mortality was 15.5 per cent (overall mortality 66 per cent). The overall mortality of venous injuries was significantly higher than the arterial ones (P less than 0.01), probably because of the dangerous complication of air embolism. Physical examination is reliable in the diagnosis of these injuries and there is no need for an emergency angiogram. The clavicular incision was the preferred approach. Repair was performed in 94 per cent of those with arterial injury. Vein injuries were treated by suture in 60 per cent and ligation in 40 per cent. A selective conservative approach is advised.
Cytokines such as interleukin‐1β (IL‐1β) and tumour necrosis factor (TNF) may play an important role in ocular inflammation. We studied a patient with clinical features of sympathetic ophthalmia secondary to previous penetrating ocular injuries, and compared the ocular and systemic levels of IL‐1β and TNF to control serum, and correlated these findings to histopathological sections of the patient's eye. Histology showed the present‐c of a diffuse chronic inflammatory infiltrate within the choroid and in a perivascular distribution in the retina. The significantly elevated ocular and systemic levels of IL‐1β and TNF suggest that there is not only a localized ocular response hut a systemic response as well. The presence of IL‐1β TNF may play a role in the pathogenesis of ocular inflammation once the blood ocular barrier has been breached and ocular antigens have been exposed to the systemic immune system.
Scleritis is a painful, destructive inflammatory eye disease. We measured serum IL‐1β) in ten patients with diffuse scleritis and in control subjects matched for age and sex. Patients with diffuse scleritis were found to have significantly elevated serum concentrations of IL‐1/β in comparison to normal subjects (P<0.02). The results suggest that IL‐l/β is associated with diffuse scleritis and may influence scleral breakdown in diffuse scleritis.
We studied prospectively 30 patients, seen over 10 months, who had herpes zoster ophthalmicus (HZO) and who were classified by age, sex, ophthalmological observations and HIV‐1 status. Of patients who presented with HZO, 40% were HIV positive, and the majority were less than 40 years of age. The clinical anifestation of HZO has a high positive predictive value for HIV positivity in young patients with this viral infection.
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