Four patients with quiescent inflammatory bowel disease had prompt exacerbations when given nonsteroidal anti-inflammatory drugs. Nonsteroidal anti-inflammatory drugs can have noxious effects on the distal intestine as well as on the proximal gut. Eight previous cases of exacerbation of ulcerative colitis have been reported, as have instances of de-novo colitis and ileitis in persons treated with nonsteroidal anti-inflammatory drugs who did not have preexisting inflammatory bowel disease. Nonsteroidal anti-inflammatory drug ingestion should be considered in the differential diagnosis of inflammatory bowel disease. These drugs should be administered to patients with inflammatory bowel disease only after consideration of their possible harmful effects.
Aims-To develop appropriate methods of eye muscle surgery in highly myopic patients with esotropia and hypotropia, with respect to the pathological findings in high resolution magnetic resonance imaging (MRI). Methods-35 patients with unilateral or bilateral high myopia and strabismusthat is, axial length of the globe averaged 29.4 mm. Multiple coronal, transverse, and parasagittal MRI image planes were obtained using a Siemens Magnetom 1.5 tesla MRI scanner. In 15 patients with a pathological plane of recti extraocular muscles found by MRI and confirmed intraoperatively, a new technique of eye muscle surgery was performed to reestablish the physiological muscle plane. This was checked postoperatively in addition to the measurement of alignment and motility by MRI. Results-The new MRI finding of a dislocation of the lateral rectus (LR) into the temporocaudal quadrant by 3.4 mm requires new surgical techniques. Only fixing the LR in the physiological meridian at the equator with a silicone loop ('guide pulley') or a non-absorbable suture is a causal therapy. This yields alignment and improves abduction and elevation. Conclusions-If the described misalignment of the LR is detected by MRI, a common high dosage recess-resect procedure for esotropia may even aggravate the deviation. The most important aim of eye muscle surgery is to normalise the pathological path of the LR. The restoration of the physiological function of the dislocated LR is remarkable. (Br J Ophthalmol 1997;81:625-630)
Using Lea symbols, a recognition acuity can be determined and amblyopia can reliably be detected. Due to their design, the Lea symbols are particularly suitable and recommendable for application in young children. However a slight systematic difference between LS and LC has to be considered.
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