We suggest that antero-posterior traction forces are the primary cause of full thickness macular holes, with these forces persisting in stage 3 and 4 macular holes, while tangential forces serve to enlarge the hole at this later stage.
In order to evaluate the Scanning Laser Ophthalmoscope as a method of assessing diabetic retinopathy, 57 consecutive patients with diabetes were examined through undilated pupils using laser ophthalmoscopy followed by pupillary dilatation and direct ophthalmoscopy. Results of laser scanning were recorded on videotape and analysed independently. Scanning (both eyes) took under 5 minutes per patient. For the 113 eyes studied, the two techniques gave concordant results in 73/113 (65%). Where there was discordance, laser ophthalmoscopic severity was greater than direct ophthalmoscopy in 36/40 (90% of discordant results). In 4/40 eyes conventional ophthalmoscopic appearances were judged more severe than those seen with the laser. The laser ophthalmoscope may have value as a method of assessing diabetic retinopathy, but further work is required to evaluate its efficacy as a screening tool in patients with moderate to severe retinopathy.
maternal pulse rate, blood-pressure, or respiratory rate with either drug. The foetal heart was slowed with both drugs at half an hour, but that from oxymorphone was significantly greater than that from pethidine. However, this significance was only at the 5% level, and was not observed at later times.To conclude, we have been unable to demonstrate that oxymorphone is superior to pethidine when the two are used alone as analgesics in labour. Past experience with drug mixturesfor example, pethidine and phenothiazine-has led to the strong clinical impression that they are more effective as analgesics and sedatives in labour than oxymorphone or pethidine alone. Certainly neither oxymorphone nor pethidine represents the ideal obstetric analgesic. SummaryThe analgesic and sedative effects of oxymorphone and pethidine have been compared in a double blind trial on 148 patients in labour. They are shown to be equally safe and effective. It is considered that neither oxymorphone alone nor pethidine alone provides adequate relief of pain in labour. Sodium fluoride has recently been reported to relieve Paget's disease of bone and idiopathic osteoporosis (Rich, 1960;Purves, 1962 ;Bernstein et al., 1963). The report below is of a patient who developed bilateral optic neuritis six weeks after beginning sodium fluoride therapy for spinal osteoporosis.CASE REPORT The patient, a man born in 1906, developed severe thoracic backache in 1961, four months after a partial gastrectomy for a chronic duodenal ulcer. He was referred to King's College Hospital in September 1962. He was then thin, kyphotic, and tender over the thoracic spinal processes. He had early finger-clubbing and wheezed on exertion. His leg pulses were reduced, and shortly afterwards a femoro-popliteal by-pass graft was successfully done for a femoral-artery occlusion. Spinal radiographs showed partial collapse of several thoracic vertebrae, with apparent rarefaction of the bones and "fish-tailing" of the vertebral bodies. His serum calcium was 9.7 mg./100 ml.; serum phosphorus 3.4 mg./100 ml.; alkaline phosphatase 5 King-Armstrong units/100 ml.; acid phosphatase 3 units/100 ml.; and haemoglobin 93%. A fat balance was normal; a calcium balance revealed a urine calcium of 200 mg.daily on an 800-1,000-mg. calcium diet. His orally along with his other drugs for six weeks. He then noticed pain and poor vision in his right eye, and five days later mistiness of vision in his left eye. He was readmitted to hospital, when he denied taking any other drugs, and his general state was found to be unchanged. His bone pain had not altered and there was no evidence of improvement of his skeletal radiographs. He was not cyanosed, there were no signs of latent tetany, both internal carotid arteries were palpable, and his blood-pressure was 130/85. There were no abnormal neurological signs except that ophthalmoscopy showed moderate oedema of the right optic disk, slight blurring of the left optic disk margin, and bilateral macular oedema. No haemorrhages or exudates were seen and t...
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