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Query: UMLS:C0018681 (headache)
 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Whilst the classical picture of tetany is easily to be diagnosed, diagnostic problems may arouse if vegetative, visceral or vascular symptoms predominate. The well-known clinical signs of provocation (Chvostek, Trousseau, Bonsdorff) frequently do not allow any diagnostic ascertainment. With the help of the classical electrodiagnostics after Erb (in the positive case the provocation of the cathodal opening contraction with an intensity of current below 5 mA is possible) or the electromyography we, as a rule, succeed in proving the diagnosis. In the EMG characteristic repetetive potentials in derivation from a small hand muscle are found, either spontaneous or after provocation by means of ischaemia and hyperventilation. The electromyographic examination is regarded as the most sensitive method in the diagnostic spectre at disposal and should be used for proving or excluding a tetany in unclear stenocardias, vasomotor circulatory disturbances, in spastic disturbances in the gastrointestinal tract, in unclear headache as well as in tetanic cataract and after operations of the thyroid gland.
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PMID:[Electromyographic diagnosis of tetany]. 122 42

Symptoms of headache, floaters, blurred vision, eye strain may be respectable outward manifestations of secret fears or failure to adjust to life events. The work in this hospital of Mr W.S. Inman, ophthalmologist and psychoanalyst, has largely been forgotten. I will present case histories to show that the approach 'Let's have a chat about your problem' can reveal deep underlying tensions. The description of these by the patient, for the first time, to a neutral listener is usually curative. It takes longer than a detachment operation and can be more difficult than cataract surgery but the end result is a very grateful patient whose symptoms have been cured--by talking. We can easily dismiss these patients with 'Your problem is not ocular'. By spending time listening and being unafraid of their muddled lives, their confused sexuality and inadequate personal relationships, we can reach a wider range of patients to help, as Inman taught our predecessors. I find it rewarding.
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PMID:Case reports on psychosomatic eye disorders. 148 9

A total of 126 children with chronic idiopathic thrombocytopenic purpura, including 35 splenectomized cases, were investigated in a long-term follow-up study, with regard to residual hematologic and immunologic abnormalities, complications and physical growth. Such hemorrhagic symptoms as petechiae, ecchymosis and epistaxis were still observed in about 22%-28% of the patients with a period of morbidity ranging from 3 to 15 years after onset. Residual thrombocytopenia below 150,000/microliters was found in 62% of patients within 5 years, 59% within 5 to 9 years and 57% within 10-14 years after onset. Other abnormalities were mild anemia, low serum level of IgA or IgM, positive antinuclear antibody, rheumatoid factor, and positive Coombs test in a small number of patients. Increased platelet-associated IgG was still obtained in patients with subnormal platelet counts whose morbid periods were 6 to 27 years after onset. Investigation of the patients by questionnaire revealed such complications as obesity, striae atrophicae, abdominal pain, headache, cataract, Perthes' disease, and cardiac complication in some patients. No apparent disturbances except for obesity were observed in their physical growth.
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PMID:Long-term follow-up study of children with chronic ITP. 275 63

1031 British optometrists completed a questionnaire to give information on their rates of referral and notification to the medical profession. Data were collected in relation to the conditions concerned, the age and sex of the patient, and the spectacle correction. Major causes of referral were cataract, glaucoma, fundus changes, headaches/migraine/eye pain and lowered visual acuity; 6.5% of all patients seen were referred to their general medical practitioner notified, and of this group it was estimated that 25-30% could have managed with reading glasses which comprised spherical lenses of equal power. If such glasses could be self-selected, without reference to a medical practitioner or optometrist, a significant number of people would not benefit from the health screening aspects of the eye examination.
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PMID:Referrals and notifications by British optometrists. 326 10

We present two cases of Werner's syndrome associated with intracranial meningioma. Characteristic clinical features of Werner's syndrome include short stature with slender extremities, premature senility, juvenile cataract, skin changes, a tendency to diabetes mellitus and familial occurrence. A 44-year-old female, who had been treated for diabetes mellitus, was diagnosed as having Werner's syndrome because of various characteristic features. A falx meningioma was incidentally found on CT scan, and was surgically removed. Her diabetes mellitus improved. The second case was a 28-year-old male was diagnosed as having Werner's syndrome, diabetes mellitus, juvenile cataract, together with diabetes insipidus, and liver dysfunction. He developed severe headache, gait disturbance and then became unconscious with right hemiparesis. He was found to have a parasagittal meningioma by CT scan and angiography. After removal of the tumor, diabetes mellitus, diabetes insipidus and liver dysfunction improved. The reported incidence of neoplasms associated with Werner's syndrome is about 10%. The majority of associated tumors were mesenchymal in origin. Ten meningiomas, 1 neurinoma and 2 gliomas are reported as associated tumors in the central nervous system. Most of the associated meningiomas were asymptomatic and found incidentally at autopsies or CT scans. Diabetes mellitus associated with Werner's syndrome is generally mild with high immunoreactive insulin value and is controllable by diet therapy and oral antidiabetic drugs. Daily profile of blood sugar improved after the removal of tumor in our cases. In 50 gm glucose tolerance test, tendency of delayed appearance of peak value, which is common in Werner's syndrome, was not altered in our cases. Discussion is made as to the association of Werner's syndrome with meningioma and diabetes mellitus.
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PMID:[Werner's syndrome associated with meningioma: case report]. 328 33

A combined technique of topical anesthesia (TA) and subconjunctival anesthesia (SCA) was used in 73 consecutive patients undergoing scleral tunnel phacoemulsification cataract surgery. Medical records were evaluated preoperatively, intraoperative, and postoperatively. A patient questionnaire was used to obtain subjective intraoperative and postoperative information. Preoperative and intraoperative sedation of varying degrees was necessary. Ninety-five percent of the patients reported no pain. No patients required additional retrobulbar or peribulbar anesthesia. The most frequent postoperative problems were pain, a need for patching, and headache. The combined TA and SCA technique appeared safe, medically acceptable, and cost-effective.
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PMID:Combined topical and subconjunctival anesthesia in cataract surgery. 765 84

This article reports the results of using subconjunctival anesthesia (SCA) in cataract surgery. Subjective patient questionnaires and the medical records of 133 consecutive SCA patients who had scleral tunnel phacoemulsification cataract surgery were analyzed. All SCA patients received preoperative medication, but most (77%) received no intraoperative medication. Most patients who had SCA (90%) reported no pain during surgery. The most common postoperative complaints were pain, patching, and headache. Uncorrected visual acuity, tested a mean time of 35 minutes after surgery, was 20/200 or better in 69% of the SCA patients. Subconjunctival anesthesia provided a safe, effective, and minimally invasive technique.
J Cataract Refract Surg 1995 Jan
PMID:Subconjunctival anesthesia in cataract surgery. 772 90

A prospective randomized study was undertaken on elderly patients undergoing intraocular, predominantly cataract, surgery to compare the intraoperative, recovery and postoperative features associated with general anaesthesia employing either the spontaneous (SV) or controlled ventilation (IPPV) techniques of respiration using isoflurane, nitrous oxide and a constant FiO2 of 0.33. SV patients received isoflurane 0.97% (mean). IPPV patients were intubated with atracurium alone, and received isoflurane 0.60% (mean). Heart rates were lower intraoperatively with IPPV, and blood pressures were lower with SV. Intraocular pressure measurement identified three subgroups of patients within each respiratory group: a large subgroup (70% of SV, 64% of IPPV patients) with a high-normal initial mean intraocular pressure which fell intraoperatively; a small subgroup (25% of SV, 24% of IPPV patients) with a low normal initial mean intraocular pressure which rose intraoperatively; and a small subgroup (5% of SV and 11% of IPPV patients) in whom the intraocular pressure remained unchanged. A satisfactory operative field was reported by surgeons in 87% of SV and in 86% of IPPV patients. SV patients had a lower mean end-operative SaO2 than IPPV patients (SV 95.0%; IPPV 96.7%), and were extubated sooner at the end of anaesthesia. In the recovery ward the times to awakening, vomiting incidences, analgesic usages and recovery times were similar, and patients were similarly restful. Postoperatively, the incidences of vomiting, headache, fever, sore throat and myalgia were similar, but SV patients required more analgesia for headache. We conclude that both technique properly performed are similarly satisfactory for cataract surgery in elderly patients.
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PMID:Clinical comparison of spontaneous respiration versus controlled ventilation general anaesthesia using isoflurane for intraocular surgery: intraoperative, recovery and postoperative effects. 789 72

Phenylephrine in concentrations of either 2.5% or 10% is widely used as a mydriatic agent in ophthalmic surgery. Its potential cardiovascular effects are seldom recorded as ophthalmic surgery is not usually monitored by an anaesthetist. A prospective randomised double blind study was carried out in 89 consecutive cases of uncomplicated cataract surgery in the presence of an anaesthesiologist ensuring the continuous monitoring of blood pressure, heart rate, electrocardiography and pulse oximetry. All these patients were given a drop of either normal saline, 2.5% or 10% phenylephrine in addition to mydriacyl prior to surgery. Blood pressure readings were found to be significantly higher in non-hypertensive patients receiving phenylephrine at the start of the operation and at five, 10, 15 and 20 minutes intra-operatively and the first three hours post-operatively. Blood pressure readings in hypertensive patients, on the other hand, were also found to increase after phenylephrine administration, though not statistically significant. 10.3% of the 10% phenylephrine group and 3% of the 2.5% phenylephrine group required intraoperative intravenous hypotensive agent to control the blood pressure. There were no arrhythmias or ischaemic changes observed intraoperatively. None of the patients complained of palpitation, headache or chest discomfort. There was no oxygen desaturation observed. We concluded that significant hypertensive effects can arise after phenylephrine eye drop administration. Hence, it should be used cautiously with intraoperative monitoring of the cardiovascular status during cataract surgery.
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PMID:Phenylephrine eye drops in ophthalmic surgery--a clinical study on cardiovascular effects. 809 95

A 67-year-old woman experienced a severe headache and vomiting. A computed tomographic (CT) scan showed a mild subarachnoid hemorrhage. Cerebral angiography revealed a saccular aneurysm at the apex of the basilar artery. Several days later, she noticed mild hemiparesis of the left extremities. She underwent a clipping operation on the aneurysm by approaching from the right temporal love. Postoperatively, she developed diplopia and dilatation of the left pupil. Cerebral angiography revealed an occlusion of the left posterior cerebral artery. She was admitted to another hospital in order to continue rehabilitation. General physical examination was normal. Neurological examination revealed paralysis of the left medial and left inferior rectus muscles and palsy of the left inferior oblique muscle. The pupil of the left eye was dilated, measuring 5 mm in diameter, and it did not constrict to any stimuli. The left superior rectus and levator palpebrae superioris functioned normally. Visual acuity and visual fields were normal except for the influence of a senile cataract. She had a mild left hemiparesis, slight left ataxia and slurred speech. She had numbness of the left half of the body. A CT scan showed small low density areas in the right thalamus and left cerebellar hemisphere. Her ophthalmologic findings were compatible with the inferior branch palsy of the oculomotor nerve. The ophthalmoplegia of this case seems to be due to partial damage of the oculomotor nerve induced by ischemia of vascular supply. It is supposed to be caused by a vasospasm of the left posterior cerebral artery following a clipping operation of the basilar apex aneurysm.
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PMID:[Inferior branch palsy of the oculomotor nerve following clipping of basilar apex aneurysm]. 831 94


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