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The authors propose to consider that the liberation of the ciliary body of Benedikt, combined or not with vitrectomy and/or with surgery of the exposed ciliary body and/or with reconstruction of the angle and/or with the treatment of secondary glaucomas with extensive goniosynechias. 30 eyes were operated according to these principles during a period of two years. They presented an angle closure glaucoma that was neglected, provoking a chronic state via the formation of a ring shaped goniosynechia (11 eyes), an aphakic secondary glaucoma (7 eyes), neo-vascular glaucoma (3 eyes), a malignant glaucoma (3 eyes), absolute glaucoma (4 eyes), or secondary glaucoma of diverse causes (2 eyes). A favourable result in the IOP control was obtained in 69% of the cases with only a minor number of complications (ciliary body hernia (5 eyes), cataract (2 eyes), choroid hematoma (1 eye). In the future, the number of undesirable results and complications should diminish as the knowledge of the principles that guide this new surgical approach of secondary glaucomas becomes better understood.
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PMID:[Surgical treatment of secondary glaucomas with extensive goniosynechias (author's transl)]. 48 8

Kasturba Hospital in Sevagram, India, has helped to initiate an outreach health program for nearby villages. A health insurance scheme has evolved where the community contributes sorghum for a fund and participates in decision-making and the supervision of village health workers. Contributors are entitled to free primary care and subsidized referral care. Only villages where at least 75% of the poor community agreed to enroll in the health insurance scheme were adopted by the hospital. The hospital offers insured persons free inpatient treatment for unexpected illness and a 75% subsidy for care during normal pregnancy or with cataract and hernia operations. The mobile health team, comprising auxiliary nurse-midwife, social worker, and village health worker, provides maternal and child health services in the localities. The village health workers provide symptomatic drug treatment, exercise a preventive role with the help of visiting health team members, and refer patients to hospital. The auxiliary nurse-midwife and social workers organize visits for vaccination and provide maternal and child health care. The doctor in charge treats patients in the hospital and trains village health workers. More than 75% of the villages in the area have enrolled in the scheme over the last 10 years. No vaccine-preventable illness (measles, poliomyelitis, diphtheria, whooping cough, tetanus) was reported in children or mothers after mass immunization was instituted, no maternal deaths have occurred during the past 10 years, and perinatal mortality has fallen steeply. The village health teams are now regarded as counselors on health-related matters, among them drinking-water supplies, irrigation, and programs for income generation. It is necessary to regulate the private health sector, including professionals, the drug industry, and investors. If outpatient services are opened up to the private sector, a system of universal medical insurance, financed by local government, should operate.
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PMID:Risk-sharing in rural health care. 141 30

Aphakic pupillary block glaucoma and malignant glaucoma (ciliovitreal block) are severe complications of the intracapsular cataract extraction, presenting clinically as elevated intraocular pressure, persistent shallow anterior chamber and severe vitreal hernia. Six eyes (four women and two men) with aphakic pupillary block glaucoma and aphakic malignant glaucoma were resolved by Neodymium: YAG laser iridotomy and hyaloidotomy. The laser therapy resulted in immediate deepening of the anterior chamber and reducing of intraocular pressure. No side effect was observed. Neodymium: YAG laser iridotomy and hyaloidotomy may be more effective and simple than penetrating surgery in such cases.
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PMID:Neodymium: YAG laser therapy in aphakic pupillary block glaucoma and aphakic malignant (ciliovitreal block) glaucoma. 210 52

Caspar Stromayr, ophthalmologist and hernia surgeon, is credited with writing the first German ophthalmic work of known authorship. Written in about 1559 as an appendix to Practica Copiosa, a larger work on hernia surgery, the ophthalmic chapters describe Stromayr's thoughts on the etiology and treatment of cataract. Stromayr, a master craftsman, also expresses his hostility to the shams and ignorance of the charlatan eye surgeons of his day. This interesting historical article provides a biographical sketch of Stromayr, a description of his book, and a translation of two chapters, "On Cataract of the Eye: How They Take Their Beginning and Whence they Come" and "How You Recognize the Cataract, When It is Ripe to Recline or to be Taken Away."
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PMID:Caspar Stromayr: sixteenth century ophthalmologist. 223 60

A survey of 31,224 patients on 33 of the largest inpatient surgical waiting lists in Wales and the West Midlands was undertaken in 1986. 19% of the patients were older than 64 years and over 90% lived within their district of treatment or in an adjacent district. Patients awaiting operations for hernia, varicose veins, arthroscopy, cataract, tonsils and adenoids, or sterilisation made up 45% of the lists. 45% of patients had already waited over a year for treatment, and it was evident that many of the lists had not been properly reviewed.
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PMID:The anatomy of large inpatient waiting lists. 288 95

Of 99 children in the Royal Blind School, Edinburgh (which serves Scotland and part of N E England), 15 had optic atrophy (hydrocephalus 4, intracranial haemorrhage 2, prematurity 2, fetal distress 2, birth asphyxia 2, cerebral atrophy 1, cardiac arrest during hernia operation 1, and leukaemia 1). Fourteen had congenital cataract, 12 congenital retinal aplasia (Leber's congenital amaurosis) and 11 retinopathy of prematurity. There were small numbers in many other diagnostic categories, including three with non-accidental head injury. Mental retardation, spasticity, and nystagmus were frequent other correlates in all diagnostic categories. 'Very probably hereditary' was a conservative attribution in 36, while 'probable' seemed appropriate for 12-that is, almost 48% were hereditary. Only about 11 cases might have been prevented through genetic counselling, which testifies to the frequency of autosomal recessive hereditary disease, although no parents were consanguineous.
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PMID:Blindness in schoolchildren: importance of heredity, congenital cataract, and prematurity. 365 73

The number of elderly patients is increasing in all countries. It is estimated that about half of those over 65 will require an operation at some time, most commonly for cataract, prostatic hypertrophy, hernia, gallstones or fractured hip. Whilst overall morbidity and mortality is considerably increased in this age group, it does not appear to result from an increased liability to surgical complications, but rather to the complications of old age itself. The fundamental factor of ageing is a decreased capacity for adaptation, and this applies to virtually all organs and systems. Surgeons and anaesthetists must make allowances for these changes. Most important are cardio-respiratory limitations and altered pharmacokinetics and pharmacodynamics affecting drug action and elimination. These will be discussed in relation to the perioperative period. Once these are understood there should be no hesitation in accepting elderly patients for any form of surgery, provided the likely benefits outweigh the increased risk. Much discomfort in old age can be alleviated by a careful choice of surgery.
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PMID:Perioperative problems in elderly patients. 368 1

Corneovitreal attachment represents a major risk to the corneal graft in aphakic eyes. A frequent event after cataract extraction is the hernia-like prolapse of the vitreous into the anterior chamber, sometimes up to the posterior surface of the cornea. Herniation of the vitreous can also occur when keratoplasty and cataract extraction are carried out simultaneously. If the vitreous adherens to the cornea, the young graft becomes opaque. The possibility of vitreous hernia is the most important objection against combined operation. In a few of our cases the cause of the opacification of the graft was corneovitreal contact following the spontaneous internal prolapse of the vitreous. Clear evidence of this was found in the course of reoperations. The opaque grafts obtained proved to be hyalokeratopathies histologically.
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PMID:[Hyalokeratopathy of the corneal graft caused by spontaneous herniation of the vitreous (author's transl)]. 704 6

We wished to identify the types and frequencies of malformations among continuing pregnancies exposed to chorionic villus sampling (CVS) and to determine whether selected procedure-related variables differ between the normal and anomalous cohorts. CVS was performed in 1048 patients between May 1988 and January 1992. Prospective assessment of perinatal outcome was ascertained by (1) physician-patient phone contact within 1 week of sampling, (2) ultrasound evaluation of the fetal anatomy at mid-gestation, (3) a detailed post-partum questionnaire completed by the referring obstetrician, and (4) a telephone interview with each patient after the expected date of confinement. Twenty-seven major malformations were documented among 938 pregnancies (live born, n = 934; electively terminated, n = 4), and included cardiac malformations (5), hypospadias (5), craniosynostosis (2), pyloric stenosis (2), inguinal hernia (2), polydactyly (2), syndactyly, distal extremely hemimelia, anencephaly, hydrocephalus, cleft lip and palate, omphalocele, diaphragmatic hernia, thanatophoric dysplasia, and unilateral cataract. Normal and anomalous cohorts were similar with respect to sampling method (transabdominal/transcervical ratio), mean gestational age at CVS, single-pass success rate, and mean total sample weight. No relationship between any procedure-related variable and the risk of malformation was observed.
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PMID:Congenital malformations subsequent to chorionic villus sampling: outcome analysis of 1048 consecutive procedures. 793 77

At the Hospital in Lund a new central building was opened in 1850 bringing the total number of beds up to 150. In the same year the hospital was divided into one "External" department including surgery and the maternity ward and one "Internal" including medicine and the ward for venereal diseases. We reviewed the patient charts and the yearly reports from 1851 to 1860 including 40 autopsy reports from this period. During these years, 8,785 patients were admitted, 2,292 of these for syphilis. Mean hospitalization time in the surgical department was 55-60 years, average 35-45 days, in the medical department a mean of around 45 days. The longest hospital stay was 350-900 days, mostly for patients with joint diseases, probably mainly tuberculosis. The number of patients admitted each year, the number of hospital days, age distribution of the patients and costs are presented in diagrams. The mean age of the patients was around 28 years, and the largest 5-year group was 16-20 years. Syphilis, various manifestations of tuberculosis and different kinds of diffuse gastric trouble were dominating diagnoses. Infectious diseases were common and serious during these years, but only very few patients, apart from the diagnoses mentioned above, were admitted to the hospital. Chlorosis, anaemia and rheumatic disorders were common. Hirudines, cupping, in some cases venesection or cauterization, locally irritating cataplasms, laxatives and enemas were dominating parts of the therapeutic resources. The operative activity was very moderate, only a total of 275 operations were performed for incarcerated hernia, stone, cataract, external tumour and injuries. Medical drugs were collected mostly from plants but various preparations of iron, mercury and lead and their salts were also frequently used. Quinine was the only drug for fevers, not only for malaria,. Several lay "bonesetters" were active in the area, the best known of whom, belonging to a family active for 200 years, were mentioned with some criticism in a few patient charts. Clinical education for the medical students was conducted by A.S. Bruzelius, director of the "Institutum Clinicum", and the professors of surgery and medicine had only limited access to inpatients for their teaching. In 1850, Bruzelius was relieved from the teaching of internal medicine, and this became the reason to divide the hospital into the two departments. The organization of medical education in Sweden was much discussed during most of last century after the Karolinska Institute in Stockholm was opened in 1812 as an addition to the universities in Uppsala and Lund. In 1859 a committee suggested that, since the number of patients available for the medical students in Uppsala and Lund (which we can verify for Lund) were very modest compared to the hospitals in Stockholm, all medical education should be concentrated to one medical school in Stockholm. Fortunately, it all ended with a compromise. Otherwise, the two universities might have been closed completely, since the faculties of medicine were very important parts of the universities of this time.
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PMID:[The hospital in Lund during the 1850's]. 1163 43


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